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Objective To quantify the documented consent outcomes for ambient monitoring technologies in an academic hospital and evaluate whether documented consent acceptance differed by age, gender, and race. Patients and methods We performed a retrospective cross-sectional study of 9,522 consecutive patients approached for ambient monitoring consent during routine hospital care from 1/1/2025 to 2/12/2026. Consent status was categorized as received, refused, or missing/unable. The primary multivariable analysis used a binary outcome of documented acceptance (received vs. refused or missing/unable) modeled with age, gender, and race. Secondary models used age categories. Results Overall, 9,125 patients (95.8%) consented, 184 (1.9%) refused, and 213 (2.2%) had missing or unobtainable consent. Acceptance did not differ by gender (95.6% among female patients vs. 96.1% among male patients; adjusted odds ratio [aOR] 1.11, 95% CI 0.91–1.36; p = 0.30). Compared with White patients, lower adjusted odds of acceptance were observed among Black or African American patients (aOR 0.66, 95% CI 0.49–0.88; p = 0.005) and patients categorized as Unknown/Declined/Other (aOR 0.56, 95% CI 0.37–0.83; p = 0.004). Acceptance was highest among Asian patients, but the adjusted difference was not significant (aOR 2.44, 95% CI 0.90–6.59; p = 0.079). Acceptance exceeded 95% across all age groups and was highest among patients aged 65–74 years (96.7%). Younger patients more often refused, whereas older patients more often had missing or unobtainable consent. Conclusion Documented consent acceptance was high in this single academic hospital. Acceptance did not vary by gender, but modest differences were observed by race and age-related patterns. Consent status alone does not establish patient comprehension, voluntariness, motivation, or durable endorsement. These findings demonstrate operational feasibility while underscoring the need for transparent consent, subgroup monitoring, and prospective evaluation of patient experiences.

Background: Travel restrictions during the COVID-19 pandemic disrupted medical education and residency recruitment. National organizations including ACGME and AAN recommended virtual interviews for adult and pediatric residency programs. This study provides insights from a single-center survey of applicants’ experiences with the virtual interview process over three years. Methods: An online, anonymous survey was sent to 300 applicants who interviewed at the adult neurology residency program during the 2020–2021 (Year 1), 2021–2022 (Year 2), and 2023–2024 (Year 3) cycles. We emailed the survey after the Rank Order List Submission and collected responses over 60 days. Results: The overall response rate was 110/300 (36.7%) over three years; response rates by year were 45% in Year 1, 31% in Year 2, and 34% in Year 3. The majority were non-US IMGs (59% in Year 1, 61.3% in Year 2, 47% in Year 3). In Years 1 and 2, most applicants applied to over 60 programs, with 77% doing so in Year 2. Over the application cycles, the proportion of applicants accepting fewer than 10 interviews rose from 20% to 32%, while the proportion accepting 10–20 interviews remained similar. Preference for virtual interviews numerically increased from 29% in Year 1 to 41% in Year 3. Key factors influencing the rank list were interactions with the program director (65–80% of the applicants) and program coordinator, as well as program reputation and faculty interviews. Program websites were the most valuable resource, cited by 72–76% of applicants, followed by program-run webinars, open houses, and social media. Among social media platforms, X (formerly Twitter) was found more helpful than Facebook or Reddit. Over 80% of applicants reported no time zone issues. Connectivity issues decreased numerically over the years. Conclusions: This study provides valuable insights into applicants’ experiences and perceptions of the virtual interview process. This model likely lowers applicants’ financial burden, but it is also associated with applicants’ preference for applying to more programs. Interactions with program directors and program coordinators are instrumental in influencing applicants’ ranking decisions. Future studies can build on these findings to evaluate emerging innovations in residency recruitment.

ABSTRACT BACKGROUND War refugees are prone to psychiatric ailments due to multiple psychosocial stressors. Afghan refugees remain underrepresented in psychiatric studies. Therefore, a study exploring factors contributing to their mental health disorders is essential to guide rehabilitation efforts worldwide. METHODS This descriptive cross-sectional study evaluates the demographics, psychosocial stressors, psychiatric illnesses, and psychotropic drug use among Afghan refugees visiting the Psychiatry Outpatient Department (OPD) in Islamabad, Pakistan. Convenience sampling was employed on a sample population (n) of 75 participants. Data was collected via a structured questionnaire and analyzed using SPSS v21.0. Qualitative and quantitative variables were analyzed statistically. RESULTS Nearly 64%(n=48) of the participants were female. About 46.7%(n=35) of participants were uneducated, and 53.3%(n=40) were unemployed. 86.7%(n=65) of participants were married, while 2.7%(n=2) were divorced. 91%(n=61) of the married and divorced participants had an arranged marriage, 46.3%(n=31) had 5-8 children, and 67.2%(n=45) had experienced physical and/or emotional abuse. 74.7%(n=56) of the total participants reported a loss in the family, while 77.3%(n=58) had experienced trauma. 62.7%(n=47) had depression and associated psychotropic use, e.g., SSRIs (42.7%), TCAs (16%), and Benzodiazepines (13.3%). Alarmingly, 37.3%(n=28) reported a previous suicide attempt. CONCLUSION This study explores the psychosocial stressors faced by Afghan refugees in Pakistan, including displacement, abuse, trauma, and family/income loss. It emphasizes the importance of evidence-based psychiatric care, rehabilitative interventions, and culturally sensitive care to counter psychiatric morbidities and underscores the need for future research to improve the mental health of refugees globally.

Importance Recent case reports suggest that B antigen–containing blood products may be associated with anaphylactic transfusion reactions in recipients with preformed immunoglobulin E to galactose- α -1,3-galactose (alpha-gal). Objective To test the association of local alpha-gal syndrome (AGS) prevalence and allergic transfusion reaction (ATR) in patients with blood type O. Design, Setting, and Participants In this international, multicenter, retrospective cohort study at academic medical centers, sites were assigned to AGS high- or low-prevalence clusters based on the known geographic distribution of AGS. Data were collected on platelet or plasma transfusions and ATRs during 2020 to 2024. Consecutive patients receiving platelet or plasma transfusions were included. Exposures Patients with blood type O who received B or AB units and patients with blood type O who received O units (reference group) in AGS high- and low-prevalence clusters were compared. Main Outcomes and Measures Before data collection, the hypothesis was that if transfusion-related alpha-gal syndrome (TRAGS) is a true clinical entity, excess ATRs to group B or AB units would be detected in AGS high-prevalence regions exclusively. The main measure was the overall risk ratio (RR) for ATRs to B or AB plasma or platelets in AGS high- vs low-prevalence clusters. Results In total, 558 823 platelet and plasma transfusions at 40 sites in 5 countries were analyzed, of which ATRs occurred in 1744 transfusions (0.3%). In the US AGS high-prevalence cluster (9 sites), significantly more ATRs of any severity occurred among patients with blood type O who received B or AB units vs patients with blood type O who received O units (overall RR, 3.93; 95% CI, 2.96-5.21; P < .001). In contrast, in the primary analysis of the AGS low-prevalence cluster (15 sites), excess ATRs to B or AB units were not detected. In subgroup analyses among patients with blood type O receiving B units, the RR for moderate to severe ATRs was 9.14 (95% CI, 5.39-15.52; P < .001) in the AGS high-prevalence cluster vs 2.15 (95% CI, 1.34-3.47; P = .002) in the AGS low-prevalence cluster. Outside the US, a signal consistent with TRAGS was not detected. Conclusions and Relevance This cohort study provides provocative epidemiologic evidence that TRAGS may be a unique manifestation of AGS and a previously unrecognized risk associated with transfusion. In AGS high-prevalence regions, blood collectors and hospital transfusion services should consider approaches to preventing severe ATRs from B or AB plasma or platelet units.

Abstract Objective To assess the efficacy and safety of fenfluramine in patients with Dravet syndrome (DS) stratified by age, number of previously attempted antiseizure medications (ASMs), and SCN1A pathogenic variant status. Methods In this post hoc analysis, data from three randomized controlled trials (RCTs) in patients with DS (2–18 years) were pooled and stratified by age (<4; ≥4 years), number of previous ASMs (1–3; 4–6; ≥7), and SCN1A pathogenic variant status ( SCN1A +; SCN1A −). Stratified groups were assessed and compared with the pooled placebo group (change in monthly convulsive seizure frequency [MCSF], longest convulsive seizure‐free interval, and Clinical Global Impression–Improvement [CGI–I] scale scores rated by parents/caregivers and investigators), and safety (treatment‐emergent adverse events [TEAEs]: frequency, days to onset, and proportion resolved). Results Among 348 patients included in the RCTs, 216 were randomized to fenfluramine (0.7 mg/kg/day, n = 88; 0.4 mg/kg/day [with stiripentol], n = 43; 0.2 mg/kg/day, n = 85) and 132 to placebo. Compared with placebo, fenfluramine treatment (all doses combined) resulted in greater MCSF reductions, greater increases in longest convulsive seizure‐free intervals, and a higher proportion of parents/caregivers and investigators reporting clinically meaningful improvement (“Much Improved”, “Very Much Improved”) on CGI–I scores across all stratified groups. CGI–I scores were consistent across fenfluramine doses in most stratified groups, but patients with the fewest number of previous ASMs had the greatest frequency of clinically meaningful improvement on investigator‐rated CGI–I scores. Safety outcomes were similar across all strata. Most TEAEs resolved by end‐of‐study. Significance Fenfluramine treatment was associated with improved seizure outcomes and global functioning compared with placebo regardless of age, number of previous ASMs, and SCN1A status in patients with DS. Fenfluramine was well‐tolerated; no new safety signals were identified. Further studies with larger sample sizes (including adults) and a priori inferential analyses of stratified groups are warranted. Plain Language Summary Patients with Dravet syndrome struggle with seizures and everyday life. In three studies, patients aged 2–18 years received fenfluramine or placebo (sugar pill). Fenfluramine lowered seizures without many side effects. Researchers combined results from these studies to see how fenfluramine worked in different patient groups based on age, number of previous medications, and a gene called SCN1A . They looked at seizure reduction and whether doctors felt patients had improved. In all groups, fenfluramine worked better than placebo, with similar side effects. Researchers believe fenfluramine helped these patients, but some groups were small, so these results need to be confirmed.

ABSTRACT Background ACS‐NSQIP began capturing operative approach in 2022. With increased adoption of minimally invasive (MIS) techniques for malignancy, a contemporary review of benchmark outcomes for open, laparoscopic and robotic gastrectomy is warranted. Methods We performed a retrospective cohort study of adults in ACS‐NSQIP (2022–2024) undergoing partial or total gastrectomy (CPT 43631‐4 and 43620‐2) for cancer. Outcomes included operative time, length of stay (LOS), unplanned conversion‐to‐open, and 30‐day morbidity, mortality, and readmission. Multivariable logistic regression evaluated patient and operative factors associated with morbidity. Results Among 1,459 patients (median age 66, 60.4% male), 66.8% underwent partial gastrectomy and 33.2% total gastrectomy. Approaches were 61.2% open, 19.5% laparoscopic, and 19.3% robotic. Thirty‐day mortality (1.8%), major complications (18.2%), and readmissions (10.3%) did not differ by approach. Unplanned conversion‐to‐open occurred in 14.0% of MIS. Robotic had longer median operative time of +1.2 and +1.7 h than laparoscopic and open and median −1 and −2 days shorter LOS respectively ( p < 0.001). Hypoalbuminemia (OR 3.10), CKD ≥ 3 (OR 1.75), and anemia (OR 1.48) were independently associated with major complications ( p < 0.05). Conclusion Operative approach influences operative time and LOS but not short‐term morbidity and mortality. The newly available ACS‐NSQIP operative approach variable enables approach‐specific benchmarks for cancer‐related gastrectomy.

Background Poor financial literacy and financial behaviors negatively affect the wellness and professional duties of residents and fellow physicians. Major financial missteps can create significant personal stress, leading to worsening wellness and burnout. There are currently no available comprehensive financial literacy curricula for residents and fellows for educators to use to address this gap. Methods We created and assessed the educational impact of a comprehensive 4-module curriculum that covers fundamental personal finance topics which are universally applicable to all physicians regardless of their medical and surgical specialty. We delivered the entire curriculum 6 times between November 2023 and December 2024 to anesthesia residents, internal medicine residents, and critical care fellows. We assessed their self-reported baseline financial behaviors and their knowledge and self-efficacy with core financial topics using pretest and posttest surveys. Results For the 4 modules respectively, 66 (25%), 39 (15%), 44 (17%), and 35 (13%) of 260 possible trainees completed surveys. Self-efficacy significantly increased for creating a financial plan (p<0.001), investing (p<0.001), designing a debt payoff strategy (p=0.005), selecting an asset allocation (p<0.001), selecting optimal asset locations (p<0.001), and selecting appropriate health (p<0.001)/life (p<0.001)/disability (p<0.001) insurance plans. Resident knowledge significantly increased from pretest to posttest for all 4 modules: Financial Plan & Basics of Investing (p<0.001), Budgeting & Debt Management (p=0.010), Retirement Accounts & Asset Allocation (p<0.001), and Insurance (p<0.001). Mean trainee satisfaction with the overall curriculum on a 5-point scale (1-low, 5-high) was 4.2 (standard deviation 0.8). Conclusions We identified poor baseline financial literacy and behaviors in our resident and fellow physicians. This prioritized curriculum effectively adapted to the needs of multiple different training programs and was highly desired by trainees. This curriculum increased their knowledge and self-efficacy with several key topics in personal finance.

Objective: To determine whether sleep apnea–specific hypoxic burden (SASHB) is associated with self-reported hypertension beyond conventional obstructive sleep apnea metrics in rail workers. Methods: Cross-sectional study of 84 Argentine rail workers undergoing home sleep apnea testing. Associations between SASHB and hypertension were evaluated using adjusted logistic regression. Drowsy driving was examined as an unadjusted exploratory secondary outcome. Results: Higher SASHB was independently associated with hypertension in the fully adjusted model (OR per SD 2.42; 95% CI 1.24–5.29; p=0.015). Higher SASHB was also associated with more severe self-reported drowsy driving in unadjusted exploratory ordinal analyses (OR per SD 1.78; 95% CI 1.09–3.28; p=0.035). Conclusions: SASHB may provide complementary information beyond conventional OSA metrics for cardiovascular risk assessment in occupational populations.

SUMMARY OBJECTIVE: The aim of this study was to estimate the prevalence of isthmocele using transvaginal ultrasound, magnetic resonance imaging and diagnostic hysteroscopy. METHODS: A cross-sectional study conducted from 2020 to 2022 in tertiary academic hospital with ninety non-pregnant women with a history of cesarean section. Transvaginal ultrasound (n=90), magnetic resonance imaging (n=65) and office diagnostic hysteroscopy (n=81) were performed within a short interval for each patient. RESULTS: The women had a mean age of 34.8±6.3 years, mean number of 2.0±1.1 cesarean sections and mean duration of 40 months since their last cesarean. The prevalence of isthmocele with 95%CIs was 11.3% (5.5–19.7%) on transvaginal ultrasound, 66.1% (53.3–77.4%) on magnetic resonance imaging, and 43.2% (32.2–54.6%) on diagnostic hysteroscopy. When transvaginal ultrasound was considered reference, accuracy for diagnostic hysteroscopy was 57.89% (44.1%; 70.6%) and magnetic resonance imaging, 43.86% (30.9; 57.5%); when magnetic resonance imaging was reference, accuracy for diagnostic hysteroscopy was 54.39% (40.75; 67.43%). Agreement analysis (kappa) among the methods showed low scores between diagnostic hysteroscopy and magnetic resonance imaging regarding transvaginal ultrasound (0.126, p<0.001 and 0.103, p<0.001, respectively) and between diagnostic hysteroscopy and magnetic resonance imaging (0.206, p=0.014). CONCLUSION: The prevalence of isthmocele was lower in transvaginal ultrasound and higher in magnetic resonance imaging. Accuracy varied from 43 to 58% among the three methods and agreement between tests for diagnosing isthmocele was low.

Urinary urea is a key biomarker for tracking protein oxidation and nitrogen balance. A persistent analytical limitation is that conventional total-nitrogen assays do not deconvolute urinary urea from urinary ammonia, and direct measurement still requires capital-intensive clinical analyzers. Here, we implement and independently validate two cost-effective methods that resolve urinary urea by pairing the presence and absence of urease: Method 1 is a urease-coupled potentiometric assay using an ammonium ion-selective electrode (ISE method); Method 2 is a microplate Berthelot–salicylate colorimetric assay employing a repurposed consumer-grade aquarium ammonia test kit (API®) (API method). Each method was validated against the Roche Cobas C311 clinical analyzer (ISE for urinary ammonia and API for urinary urea) in healthy adult volunteers (n = 10 each), and API–ISE were then compared head-to-head for urinary urea. ISE vs. Cobas yielded R2 = 0.967, slope 95% CI [0.867, 1.173], and Bland–Altman bias of −1.02 mM (95% LoA [−7.40, +5.36] mM). API vs. Cobas yielded R2 = 0.973, slope 95% CI [0.790, 1.039], and bias of −1.55 mM (95% LoA [−11.56, +8.46] mM). API–ISE urinary urea comparison confirmed mutual agreement (R2 = 0.9976, slope 95% CI [0.946, 1.024]; bias of +3.47 mM; 95% LoA [−14.60, +21.53] mM), with mean recoveries near 100% (API: 100.7 ± 2.9%; ISE: 100.6 ± 5.4%; 20–350 mM). Both methods agreed with the clinical analyzer, supporting their potential for decentralized, resource-limited testing; clinical and point-of-care validations are needed.