Functional near-infrared spectroscopy (fNIRS) is being extensively explored as a potential primary screening tool for major depressive disorder (MDD) because of its portability, cost-effectiveness, and low susceptibility to motion artifacts. However, the fNIRS-based computer-aided diagnosis (CAD) of MDD using deep learning methods has rarely been studied. In this study, we propose a novel deep learning framework based on a convolutional neural network (CNN) for the fNIRS-based CAD of MDD with high accuracy.

Heterogeneous findings among anxiety disorder studies have hindered elucidation of the underlying pathophysiology and the development of mechanism-based therapies.

Many countries used digital health solutions to support COVID-19 vaccination but struggled to implement them, resulting in adaptations. This theory-driven mixed methods evaluation of COVID-19 vaccine-related data and digital interventions from the Democratic Republic of the Congo, Niger and Vietnam aimed to uncover (i) what drove mid-course adaptations of these digital health interventions, (ii) how these adapted interventions may have contributed to improved availability, quality and use of COVID-19 vaccine-related data and (iii) if and how these interventions strengthened eHealth building blocks. Methods consisted of interviews, document review, secondary data analysis and observation. Findings indicated that decisions to adapt original interventions were driven by need and the availability of funding. Adapted interventions improved the availability and quality of data. Data use improved in all three countries although there were ongoing challenges observed in the Democratic Republic of the Congo and Niger. The interventions did not appear to strengthen the eHealth building blocks, although in the Democratic Republic of the Congo and Niger they had positive effects on routine immunization systems. Achieving longer-term improvements in eHealth building blocks requires intentional focus from the design stage, which may be more challenging in an emergency context. Abrégé De nombreux pays ont utilisé des solutions de santé numériques pour appuyer la vaccination contre la COVID-19, mais ont eu du mal à les mettre en œuvre, ce qui a conduit à des adaptations. Cette évaluation à base théorique des données liées au vaccin contre la COVID-19 et des interventions numériques de la République démocratique du Congo, du Niger et du Vietnam vise à découvrir (1) ce qui a motivé les adaptations à mi-parcours de ces interventions de santé numérique, (2) comment ces interventions adaptées ont pu contribuer à accroître la disponibilité, la qualité, et l'utilisation des données relatives au vaccin contre la COVID-19 et (3) si et comment ces interventions ont renforcé les composantes de cybersanté. Les méthodes ont compris des entretiens, un examen des documents, une analyse des données secondaires et l'observation. Les résultats indiquent que les décisions d'adapter les interventions originales étaient dictées par les besoins et la disponibilité des financements. Les interventions adaptées ont permis d'accroître la disponibilité et la qualité des données. L'utilisation des données s'est améliorée dans ces trois pays, bien que des problèmes persistent en République démocratique du Congo et au Niger. Les interventions n'ont pas semblé renforcer les composantes de cybersanté, bien qu'elles aient eu des effets positifs sur les systèmes de vaccination systématique en République démocratique du Congo et au Niger. Améliorer les composantes de cybersanté nationales sur le plus long terme exige une intentionnalité accrue dès la phase de conception, ce qui peut être plus difficile dans un contexte de crise. Resumen Muchos países utilizaron soluciones de salud digital para apoyar la vacunación contra la COVID-19, pero tuvieron dificultades para implementarlas, lo que dio lugar a adaptaciones. Esta evaluación de los datos relacionados con la vacuna contra la COVID-19 y las intervenciones digitales realizadas en la República Democrática del Congo, Níger y Vietnam, basada en la teoría y en métodos mixtos, tiene como objetivo descubrir: (1) qué impulsó las adaptaciones de estas intervenciones de salud digital a medio camino, (2) cómo estas intervenciones adaptadas pueden haber contribuido a mejorar la disponibilidad, la calidad y el uso de los datos relacionados con la vacuna contra la COVID-19, y (3) si estas intervenciones fortalecieron los componentes básicos de la cibersalud y cómo lo hicieron. Los métodos consistieron en entrevistas, revisión de documentos, análisis de datos secundarios y observación. Los hallazgos indicaron que las decisiones de adaptar las intervenciones originales fueron impulsadas por la necesidad y la disponibilidad de fondos. Las intervenciones adaptadas mejoraron la disponibilidad y la calidad de los datos. El uso de datos mejoró en los tres países, aunque se siguieron observando problemas en la República Democrática del Congo y Níger. Las intervenciones no parecieron fortalecer los componentes básicos de la cibersalud, si bien en la República Democrática del Congo y Níger tuvieron efectos positivos en los sistemas de vacunación sistemática. Para lograr mejoras a largo plazo en los componentes básicos de la cibersalud se requiere un enfoque deliberado desde la etapa de diseño, lo que puede resultar más difícil en un contexto de emergencia.

With the unprecedented scale and scope of the COVID-19 vaccination response, many countries used digital systems to capture vaccine administration data. Data backlogs, a build-up of information captured via paper forms not yet entered into digital systems, were common across countries. This study aimed to identify the root causes of COVID-19 vaccination data backlogs in the Democratic Republic of the Congo, Kenya, Senegal and Tanzania based on primary (interviews and observations at vaccine delivery sites) and secondary data. Root causes of data backlogs were related to technology (system slowdowns, insufficient devices and limited system functionality), infrastructure (lack of reliable internet and data bundles), processes (incongruence between paper and digital tools, separate data collection and entry, lack of integration with routine immunization and lack of standard operating procedures) and people (staff shortages, large workloads and non-payment of staff). Recommendations to inform digital and data systems include: (i) use a country-led, coordinated, iterative approach for system design and introduction, (ii) start with a minimum viable product and (iii) proactively address the needs of the health workforce. As the COVID-19 global emergency ends, these findings can help inform broader health system strengthening efforts to improve effectiveness, resilience and pandemic preparedness. Abrégé Face à l’ampleur et à la portée sans précédent de la campagne vaccinale contre la COVID-19, de nombreux pays ont utilisé des systèmes numériques pour recueillir des données sur l’administration du vaccin. Tous les pays ont connu des retards de données, soit une accumulation d’informations recueillies au moyen de formulaires papier qui n’avaient pas encore été saisies dans les systèmes numériques. Cette étude vise à cerner les causes premières de ces retards de données sur la vaccination contre la COVID-19 en République démocratique du Congo, au Kenya, au Sénégal et en Tanzanie sur la base de données primaires (entretiens et observations sur les sites d’administration du vaccin) et secondaires. Les causes premières des retards de données étaient liées à la technologie (ralentissements des systèmes, insuffisance des appareils et fonctionnalité limitée des systèmes), à l’infrastructure (absence de forfaits de données et de liaison Internet fiables), aux processus (incompatibilité entre les outils papier et numériques, collecte et saisie séparées des données, manque d’intégration avec les vaccinations de routine et absence de procédures opérationnelles normalisées) et au personnel (manque d’effectifs, charges de travail importantes et non-paiement du personnel). Les recommandations pour informer les systèmes numériques et de données comprennent: (i) utiliser une approche itérative, coordonnée et dirigée par les pays pour la conception et la mise en place des systèmes, (ii) commencer par un produit minimum viable et (iii) répondre aux besoins du personnel de santé en amont des problèmes. La crise mondiale liée à la COVID-19 touchant à sa fin, ces résultats sont susceptibles d’éclairer les efforts de renforcement des systèmes de santé dans leur ensemble visant à améliorer l’efficacité, la résilience et la préparation aux pandémies. Resumen Ante la escala y el alcance sin precedentes de la vacunación como respuesta a la COVID-19, muchos países utilizaron sistemas digitales para registrar datos sobre la administración de las vacunas. En todos los países era común que la información recabada a través de formularios en papel se acumulara sin ingresarse en los sistemas digitales. El objetivo de este estudio consistió en identificar las causas fundamentales de la acumulación de datos sin procesar sobre la vacunación contra la COVID-19 en la República Democrática del Congo, Kenia, Senegal y Tanzania a partir de datos primarios (entrevistas y observaciones en los sitios de vacunación) y secundarios. Las causas fundamentales de esa acumulación estaban relacionadas con la tecnología (desaceleraciones del sistema, dispositivos insuficientes y funcionalidad limitada del sistema), la infraestructura (falta de conexión confiable a Internet y paquetes de datos), los procesos (incongruencia entre las herramientas en papel y las digitales, recopilación e ingreso de datos por separado, falta de integración con la inmunización de rutina y falta de procedimientos operativos estándar) y las personas (escasez de personal, grandes cargas de trabajo y falta de pago del personal). Las siguientes son algunas recomendaciones para los sistemas digitales y de datos: (i) utilizar un enfoque iterativo, coordinado y dirigido por el país para el diseño y la introducción del sistema, (ii) comenzar con un producto mínimo viable y (iii) atender de manera proactiva las necesidades del personal de la salud. Ahora que está terminando la emergencia mundial de COVID-19, estos hallazgos pueden servir de base a esfuerzos más amplios de fortalecimiento del sistema de salud dirigidos a mejorar la efectividad, la resiliencia y la preparación para pandemias.

The U.S. Agency for International Development's Data for Implementation project supported the Ministry of Health in Honduras' Central District and San Pedro Sula health regions to implement a new situation room methodology to analyze data and make timely, informed decisions during the pandemic. This mixed-methods study explored if the new methodology contributed to increased workforce capacity in data use and improved leadership and governance at the regional level from 2022 to 2023. We administered a self-assessment questionnaire and semi-structured interviews to situation room participants, regional health authorities and Data.FI staff to unveil perceptions around mastery, proficiency and confidence of data use knowledge and skills and to explore any perceived changes in the digital health enabling environment. After one year of situation room implementation, most participants reported being 'competent' or 'expert' in analysis and data visualization (59%) and being 'very confident' or 'confident' in applying data use competencies (83-93%). The thematic analysis revealed five themes indicating changes in the enabling environment. Three of the themes-data analysis and visualization, peer collaboration and replicability-fall under the World Health Organization's workforce eHealth building block; two of the themes-leadership and governance of health data-fall under the leadership and governance eHealth building block. This study demonstrates the value of situation rooms as a capacity strengthening intervention and as an opportunity for use during new health emergencies. Abrégé Le projet « Data for Implementation » de l'Agence des États-Unis pour le développement international (USAID) a permis au département de la santé des régions sanitaires du district central et de San Pedro Sula du Honduras de mettre en œuvre une nouvelle méthodologie des centres opérationnels stratégiques pour analyser les données et prendre des décisions éclairées et opportunes pendant la pandémie. Cette étude à méthodes mixtes visait à déterminer si la nouvelle méthodologie avait contribué à accroître les capacités des effectifs en matière d'utilisation des données et à améliorer le leadership et la gouvernance à l'échelle régionale de 2022 à 2023. Nous avons soumis aux participants des centres opérationnels stratégiques, aux autorités sanitaires régionales et au personnel de Data.FI un questionnaire d'autoévaluation et nous avons mené des entretiens semi-structurés auprès d'eux pour cerner leurs perceptions concernant la maîtrise, l'aptitude et la confiance des connaissances et des compétences en matière d'utilisation des données et pour étudier tout changement perçu dans l'environnement propice à la santé numérique. Après un an de mise en œuvre en centre opérationnel stratégique, la plupart des participants se sont déclarés « compétents » ou « experts » en analyse et visualisation de données (59%) et « très confiants » ou « confiants » dans l'application de leurs compétences en matière d'utilisation des données (83 à 93%). L'analyse thématique a révélécinq thèmes indiquant des changements dans l'environnement favorable. Trois de ces thèmes (analyse et visualisation des données, collaboration entre pairs et reproductibilité) relèvent des piliers de la santé numérique des effectifs de l'Organisation mondiale de la santé (OMS); deux des thèmes (leadership et gouvernance des données de santé) relèvent du module leadership et gouvernance de la santé en ligne. Cette étude démontre la valeur des centres opérationnels stratégiques en tant qu'interventions de renforcement des capacités et en tant qu'occasions d'utilisation lors de nouvelles urgences sanitaires. Resumen El proyecto Data for Implementation de la Agencia de los Estados Unidos para el Desarrollo Internacional (USAID) asistió a la Secretaría de Salud de Honduras en las regiones sanitarias del Distrito Central y San Pedro Sula para implementar una nueva metodología de salas situacionales con el fin de analizar datos y adoptar decisiones oportunas e informadas durante la pandemia. En este estudio de métodos mixtos se examinó si la nueva metodología contribuyó a aumentar la capacidad del personal en el uso de datos y a mejorar el liderazgo y la gobernanza a nivel regional de 2022 a 2023. Administramos un cuestionario de autoevaluación y entrevistas semiestructuradas a los participantes de las salas situacionales, las autoridades sanitarias regionales y el personal de Data.FI para descubrir cuáles eran las percepciones sobre el dominio, la competencia y la confianza en el uso de datos, los conocimientos y las habilidades, y para analizar los cambios percibidos en el entorno propicio para la salud digital. Después de un año de implementación de las salas situacionales, la mayoría de los participantes declararon ser 'competentes' o 'expertos' en análisis y visualización de datos (59%) y sentirse 'muy seguros' o 'seguros' en la aplicación de las competencias de uso de datos (83-93%). El análisis temático reveló cinco temas que indican cambios en el entorno propicio. Tres de los temas (análisis y visualización de datos, colaboración entre pares y replicabilidad) corresponden al componente de recursos humanos de los sistemas de salud según la Organización Mundial de la Salud; dos de los temas (liderazgo y gobernanza de los datos de salud) corresponden al componente de liderazgo y gobernanza. Este estudio demuestra el valor de las salas situacionales como intervención de fortalecimiento de la capacidad y como oportunidad para su uso durante nuevas emergencias sanitarias.

In the context of protracted conflict, severe droughts and health system constraints, children under-five in Somalia face one of the highest mortality rates in the world. The WHO Integrated Management of Childhood Illness (IMCI) guidance targets the main causes of morbidity and mortality, but adherence is low. We implemented the ALgorithm for the MANAgement of CHildhood illness (ALMANACH), a digital clinical decision support system, with the aim of improving IMCI adherence whilst promoting antibiotic stewardship in South-Central Somalia. Alongside, we evaluated health service delivery and ALMANACH acceptability and impact to inform design and roll-out. A pre-post assessment involving direct observation of consultations with sick children (2-59 months) based on the Demographic and Health Surveys Service Provision Assessment, complemented by exit interviews with caregivers and feedback from healthcare staff and stakeholders. Over 600 consultations were observed in each assessment period, in seven health facilities. ALMANACH had a significant impact on antibiotic prescription (reduction from 58.1% pre- to 16.0% post-implementation). This was particularly pronounced among certain conditions such as upper respiratory tract infections (30-fold reduction, RR = 0.03). Large differences in guideline adherence were observed (danger signs: 1.3% pre- to 99% post-implementation; counselling on follow-up: 12% pre- to 94% post-; and Vitamin A supplementation need checked: 19.9% pre- to 96.1% post-implementation). ALMANACH was found to be acceptable to caregivers, healthcare providers and stakeholders, with reports of positive impact on perceived quality of care. Implementation of ALMANACH in primary healthcare in Somalia significantly improved quality of care and guideline adherence, supporting the use of ALMANACH and similar tools to improve healthcare in fragile and resource-constrained settings.

Investigating the mechanism of differentiating similar representations, known as pattern separation, has primarily focused on the hippocampus. The roles of cortical regions and their interaction with the hippocampus remain largely unclear. In this study, we address this topic by analyzing whole-brain, high-resolution mnemonic similarity task (MST) fMRI data collected with a 7-Tesla MR scanner. Structural and functional MRI data were acquired from 55 non-demented elderly subjects. During the encoding phase of the MST task, participants responded with "indoor" or "outdoor" to 66 everyday objects. In the recognition phase, participants were asked to make "same" / "similar" / "new" judgments about objects that were either the same as previously seen objects (targets), similar but different from previously seen objects (lures), or new objects (foils). A general linear model was conducted on hippocampal regions of interest (ROIs) and at the whole-brain level with five conditions, including "new" response to foils (foil), "same" response to targets (hit), correct "similar" response to lure (lure correct rejection, LureCR), false "same" response to lure (lure false alarm, LureFA), and one condition for all others. The activity difference when lures were identified as "similar" compared to "same" (LureCR vs. LureFA) was used to assess if a region is involved in pattern separation. An association analysis was conducted to test if lure discrimination performance was correlated with activity difference of hippocampal ROIs between LureCR and LureFA, as well as age. Task-based functional connectivity between hippocampal ROIs and other regions involved in pattern separation was examined. In the hippocampal ROI analysis, left anterior CA3/DG showed greater activity in LureCR condition compared to LureFA. All other hippocampal ROIs did not show differential activity. Better lure discrimination performance was associated with larger activity difference between LureCR and LureFA at left anterior CA3/DG and right anterior subiculum. In the whole-brain analyses, regions in the frontoparietal network (FPN) consistently showed increased activity in the Hit, LureCR, and LureFA conditions, and the activity was right-lateralized for Hit and LureFA conditions but bilateral for LureCR condition. Eleven clusters, mainly located in the left hemisphere, were identified to show significant activity difference between LureCR and LureFA condition, including left FPN, middle temporal lobe, and subcortical regions. In summary, with the whole-brain high-resolution MST fMRI data, regions exhibiting the pattern separation signature were found to be lateralized to the left hemisphere in elderly participants. The left and right FPN are suggested to have distinct functional roles in the MST. The right FPN contributes to retrieving previously viewed same or similar objects, while the left FPN is preferentially involved in pattern separation. Furthermore, the pattern separation process might require the coordinated effort of FPN and hippocampus, with their interaction potentially mediated by subcortical regions.

Arthropod-borne (arbo) viruses cause emerging diseases that affect the livelihoods of people around the world. They are linked to disease outbreaks resulting in high morbidity, mortality, and economic loss. In sub-Saharan Africa, numerous arbovirus outbreaks have been documented, but the circulation and magnitude of illness caused by these viruses during inter-epidemic periods remains unknown in many regions. In Rwanda, there is limited knowledge on the presence and distribution of arboviruses. This study aimed at determining the occurrence and distribution of selected arboviruses, i.e., chikungunya virus (CHIKV), o'nyong-nyong virus (ONNV), dengue virus (DENV), West Nile virus (WNV), Zika virus (ZIKV), Rift Valley fever virus (RVFV) and Crimean-Congo haemorrhagic fever virus (CCHFV), among febrile patients visiting health centres in Rwanda. A total of 2294 dry blood spots (DBS) were collected on filter papers during August 2019 - December 2020. Reverse-transcription polymerase chain reaction (RT-PCR) was performed on samples in pools of ten, using both quantitative (DENV, ZIKV, RVFV) and conventional PCR (CHIKV, ONNV, WNV, CCHFV) with virus specific primers, followed by sequencing. Demographic data and clinical manifestations of illness were analysed. ONNV infection was detected in 12 of 230 pools (5.2%) and ZIKV in three pools (1.3%). The other arboviruses were not detected. All ONNV cases were found in the Rwaniro health centre, while ZIKV infection was found among patients visiting the Kirinda and Zaza health centres. There was temporal variability in ONNV infections with most cases being recorded during the long dry season, while ZIKV infection occurred during both dry and wet seasons. Patients with ONNV were older and more were females. In conclusion, ONNV and ZIKV infection were detected in acute patients and can explain some of the feverish diseases in Rwanda.

To (1) create and evaluate the usefulness of an online evidence-based education resource about running and knee health (eg, knee osteoarthritis) for the public and health care professionals, and (2) assess the online resource's effects on perceptions about running and knee health.

Adolescence is a period of increased risk taking, including increased alcohol and drug use. Multiple clinical studies report a positive relationship between adolescent alcohol consumption and risk of developing an alcohol use disorder (AUD) in adulthood. However, few preclinical studies have attempted to tease apart the biological contributions of adolescent alcohol exposure, independent of other social, environmental, and stress factors, and studies that have been conducted show mixed results. Here we use several adolescent voluntary consumption of alcohol models, conducted across four labs in three institutes and with two rodent species, to investigate the ramifications of adolescent alcohol consumption on adulthood alcohol consumption in controlled, pre-clinical environments. We consistently demonstrate a lack of robust increases in adulthood alcohol consumption. This work highlights that risks seen in both human datasets and other murine drinking models may be due to unique social and environmental factors - some of which may be unique to humans.

The gold standard test for diagnosing sleep-disordered breathing is polysomnography; however, its limited availability has led to the emergence of alternatives such as polygraphy, which is more accessible and cost-effective.

Ammonia is the primary component of malodorous substances in chicken farms. Currently, the microbial ammonia reduction is considered a potential method due to its low cost, high safety, and environmental friendliness. Sphingomonas sp. Z392 can significantly reduce the ammonia level in broiler coops. However, the mechanisms of ammonia nitrogen reduction by Sphingomonas sp. Z392 remain unclear. To explore the mechanisms of ammonia reduction by Sphingomonas sp. Z392, the transcriptome and metabolome analysis of Sphingomonas sp. Z392 under high ammonium sulfate level were conducted. It was found that the transcription levels of genes related to purine metabolism (RS01720, RS07605, purM, purC, purO) and arginine metabolism (glsA, argB, argD, aguA, aguB) were decreased under high ammonium sulfate environment, and the levels of intermediate products such as ornithine, arginine, IMP, and GMP also were also decreased. In addition, the ncd2 gene in nitrogen metabolism was upregulated, and intracellular nitrite content increased by 2.27 times than that without ammonium sulfate. These results suggested that under high ammonium sulfate level, the flux of purine and arginine metabolism pathways in Sphingomonas sp. Z392 might decrease, while the flux of nitrogen metabolism pathway might increase, resulting in increased nitrite content and NH3 release. To further verify the effect of the ncd2 gene on ammonia removal, ncd2 was successfully overexpressed and knocked out in Sphingomonas sp. Z392. ncd2 Overexpression exhibited the most ammonia reduction capability, the ammonia concentration of ncd2 overexpression group decreased by 43.33% than that of without Sphingomonas sp. group, and decreased by 14.17% than that of Sphingomonas sp. Z392 group. In conclusion, Sphingomonas sp. Z392 might reduce the release of NH3 by reducing the flux of purine and arginine metabolisms, while enhancing ammonia assimilation to form nitrite. In this context, ncd2 might be one of the key genes to reduce ammonia.

Antibiotic-resistant genes (ARGs) pose a significant challenge in modern medicine, rendering infections increasingly difficult to treat as bacteria acquire mechanisms to resist antibiotics. Addressing ARGs necessitates a multifaceted approach, encompassing surveillance efforts to monitor their presence and the development of strategies aimed at managing and curbing the spread of antibiotic resistance. Hence, this study characterized the genetic determinants of antibiotic resistance among isolates responsible for Lower Respiratory Tract Infections (LRTIs) in People Living with HIV/AIDS (PLWHA) in Uyo.

Mental health describes an individual's emotional, psychological, and social well-being. The diagnosis of precancers and cancers may result in different mental health manifestations. This review will examine the existing evidence on the effects of diagnosis, management, and prognosis of the four common gynaecological malignancies (ovarian, endometrial, cervical cancer, and endometrial trophoblastic neoplasia) and two precursor lesions (premalignant lesions of the cervix and hydatidiform mole) on the mental health of affected women in Sub-Saharan Africa (SSA).

The overprescription of opioids for pediatric orthopaedic surgery patients is a concerning issue due to the risks of misuse, diversion, and prolonged use. Despite this, evidence-based guidelines for opioid prescribing in this population are lacking. This systematic review aimed to characterize current opioid prescription practices and utilization following pediatric orthopaedic procedures. We conducted a systematic literature search in October 2023 using PubMed, MEDLINE, Embase, and additional sources to identify studies reporting on opioid prescriptions at discharge for pediatric orthopaedic patients. Included studies were from the United States describing the quantity prescribed and/or utilized. Mean prescription quantities and utilization rates were extracted, with opioid dosages converted to morphine milligram equivalents when possible. The search identified 14 eligible studies encompassing a range of orthopaedic procedures including spinal fusion, fracture repairs, and arthroscopy. Substantial variation existed in mean prescription quantities both across and within procedure types. Mean prescriptions ranged from no opioids for certain closed reductions to 61 pills for posterior spinal fusion. However, opioid utilization rates were generally low, with under 60% of prescribed pills taken in most studies. The highest utilization was 90.2% following spinal fusion, while the lowest was 7% for forearm fracture reductions when prescribed. Overall, lower prescription quantities and utilization rates were seen for less invasive procedures. This review describes current postoperative opioid prescription patterns and utilization rates for a range of pediatric orthopaedic surgeries. Our results suggest variability in opioid prescriptions and the potential for overprescription across many pediatric orthopaedic procedures, highlighting a need for standardized, procedure-specific prescribing recommendations. Prescribing lower opioid quantities aligned with anticipated medication requirements may reduce risks of misuse and diversion. Incorporating nonopioid analgesics and providing education on proper opioid use and disposal could further mitigate hazards.

Although utilization of dynamic suture-button fixation for adult syndesmotic injuries has shown improved outcomes over static screw fixation, data in pediatric populations is limited. This study evaluated trends in management and identified factors influencing surgeon choice of implant for pediatric syndesmotic injuries.

Most children and adolescents who have flexible pes planovalgus (PPV) are asymptomatic, however some have significant daily foot pain that limits their activities. Current acceptable treatment options are conservative measures or full foot reconstruction and at present there is no "middle ground" treatment in the United States. The Subtalar Extra-Articular Screw Arthroereisis (SESA) (aka "calcaneo-stop") procedure offers a minimally invasive option for PPV correction, and is done commonly in Europe with satisfactory results. Its not clear why this procedure has not yet been widely adopted in North America. The purpose of this study was to assess early single surgeon experience and patient satisfaction in North America with the SESA for treatment of flexible PPV.

The physiological importance of calcium and vitamin D intake, specifically in a pediatric population, is readily understood by pediatric orthopaedists. However, there is a lack of research that demonstrates caregivers' awareness regarding pediatric orthopaedic patients' bone health, such as the importance of nutrition, sunlight exposure, and supplementation. This study aims to assess the knowledge base of caregivers of pediatric orthopaedic patients and to identify associations between bone health knowledge and demographic factors. It is hypothesized that this study will not only elucidate a general lack of knowledge regarding nutritional sources of vitamin D and calcium but will also clarify the populations in which this deficit is most pronounced.

The role of stems and prefixes in complex nonword reading was investigated in unimpaired readers and five individuals with acquired dyslexia. All participants completed a reading aloud task (and the reading impaired individuals also completed a repetition task) with four different types of nonwords: prefix + stem (refront), non-prefix + stem (tefront), prefix + non-stem (refrint), non-prefix + non-stem (tefrint); and prefixed and non-prefixed filler words. The unimpaired readers responded fastest to nonwords containing two morphemes (prefix + stem), slower to nonwords with one morpheme (non-prefix + stem; prefix + non-stem), and slowest in the non-morphemic control condition (non-prefix + non-stem), providing evidence for the added benefit of prefixes and stems during reading. The five reading impaired individuals showed facilitatory morpheme effects across both tasks, but stem-effects were more robust than affix-effects. There was no difference between the prefixed and non-prefixed words in any of the data. The impact of morphological structure on nonword reading and repetition points to the important role of morphemes across different modalities..

Microvascular complications increase the risk of cardiovascular disease and premature death in adults with type 1 diabetes. We examined the association between microvascular complications during adolescence, including cardiac autonomic nerve dysfunction and subsequent mortality. Research Design and Methods. We undertook data linkage with the Australian National Death Index in a cohort of 409 adolescents (diagnosed between 1973 and 1993), 48% male, median age at final complications assessment 17.4 years (interquartile range: 16.0-18.9), followed longitudinally for median 22.3 years (21.0-23.4) from diagnosis. Generalized estimating equations (GEE) were used to examine associations between mortality and adolescent complications. Mortality risk was calculated as standardized mortality ratio (SMR).