Citations

Background: Effective communication and collaboration among clinical and nonclinical staff are critical to the health and safety of the staff, for optimal team performance and for safe patient care. While respiratory protective equipment are routine key strategies to protect healthcare workers from exposure to select respiratory pathogens, they have been demonstrated to disrupt speech intelligibility. The COVID-19 pandemic escalated the need for and utilization of respiratory protection in all healthcare settings. The purpose of this study was to evaluate the impact of various respiratory personal protection equipment (PPE) on speech intelligibility. Methods: Healthcare workers were invited to participate in audiology-based testing in which the audiologist read words from the Modified Rhyme Test (MRT) using two levels of background noise and rotating through six different types of respiratory PPE. Descriptive statistics and ANOVA were used for analysis. Findings: Modified Rhyme Test (MRT) scores were significantly lower when wearing the CleanSpace Halo (−10.22 points, 95% CI [−11.28, −9.20]) and the elastomeric half mask respirator (EHMR) with or without the exhalation valve filter (−2.28 points, 95% CI [−3.33, −1.20] and −3.22 points, 95% CI [−4.40, −2.18] respectively) after adjusting for noise level, listener respiratory PPE, and correlation within each participant. Conclusions/Applications to practice: Elastomeric half mask respirator (EHMR) decreased speech intelligibility compromising clear communications. Further research on respiratory PPE design is needed to optimize speech intelligibility and communication maximally.

Abstract Background Post-traumatic headache (PTH) is a common acute and persistent symptom following mild traumatic brain injury (mTBI). Symptoms of cutaneous allodynia and presence of nociceptive sensitization might be associated with acute PTH and its persistence. The objectives of this study were to compare allodynia symptoms and cutaneous heat pain thresholds amongst males and females with acute PTH to healthy controls (HC) and determine if pain thresholds and allodynia symptoms are associated with PTH outcomes. Methods This prospective longitudinal study enrolled 139 adults with acute PTH attributed to mTBI as defined by the International Classification of Headache Disorders and 95 HC. All PTH participants completed a baseline research visit near PTH onset and a follow-up visit three to four months later. All PTH participants and a subset of HC completed the Allodynia Symptom Checklist (ASC-12) at each research visit. A different subset of the participants underwent quantitative sensory testing (QST) during baseline, 4-week, and 16-week research visits to quantify cutaneous heat pain thresholds at the forehead and forearms. Data from daily headache diaries were used to determine longitudinal PTH improvement versus non-improvement at three months. ASC-12 score and pain threshold comparisons were made between PTH and HC groups, PTH improved versus non-improved cohorts, and between PTH males and females. Results Participants with PTH had an average age of 42.6 years and 64.0% were female. HC had an average age of 40.0 years and 65.3% were female. At the first visit, PTH participant ASC-12 scores averaged 3.6 versus 0.1 amongst HC, p < 0.001. 44.8% of PTH participants had headache improvement at 3 months. ASC-12 scores were higher in the PTH non-improved versus improved group at baseline (4.0 versus 2.4, p = 0.038) and 3-month follow-up (3.4 versus 1.9, p = 0.012). ASC-12 scores were higher in females than males at baseline (4.7 versus 1.6, p < 0.001) and 3-months (3.9 versus 1.2, p < 0.001). Cutaneous heat pain thresholds at the forehead and forearm did not differ between any group. Conclusions PTH attributed to mTBI is associated with symptoms of cutaneous allodynia. Greater allodynia symptoms are present in females with PTH compared to males and may be associated with PTH non-improvement.

Abstract Repetitive head impacts are associated with structural brain changes and an increased risk for chronic traumatic encephalopathy, a progressive neurodegenerative disease that can only be diagnosed after death. Chronic traumatic encephalopathy is defined by the abnormal accumulation of phosphorylated tau protein, particularly at the depths of the superior frontal sulci, suggesting that sulcal morphology may serve as a relevant structural biomarker. Contact sport athletes, such as former football players, are at elevated risk due to their prolonged exposure to repetitive head impacts. Cortical atrophy linked to underlying tau accumulation may result in shallower and wider sulci, potentially making sulcal morphology an imaging marker for identifying individuals at risk for this disease. This study investigated sulcal morphological differences in former football players and examined associations with age, football-related exposure, clinical diagnosis of traumatic encephalopathy syndrome, levels of certainty for chronic traumatic encephalopathy pathology, neuropsychological performance, and positron emission tomography imaging using flortaucipir. We analysed structural magnetic resonance imaging data from 169 male former football players (mean age 57.2 (8.2) years, range 45–74) and 54 age-matched, unexposed asymptomatic male controls (mean age 59.4 (8.5) years, range 45–74). Sulcal depth and width were quantified using the CalcSulc, focusing on two regions in each hemisphere commonly affected by chronic traumatic encephalopathy pathology: the superior frontal and occipitotemporal sulci. Generalized least squares models were used to assess group differences and interactions with age and football exposure variables, including age of first exposure, total years played, and cumulative head impact exposure. An analysis of covariance evaluated relationships between sulcal morphology, clinical measures, and flortaucipir uptake, adjusting for age, race, body mass index, education, imaging site, apolipoprotein E4 status, and total intracranial volume. Former football players demonstrated significantly shallower sulcal depth in the left superior frontal sulcus compared to unexposed controls. Earlier age of first exposure and longer football careers were associated with greater widening of the left occipitotemporal sulcus. Higher cumulative head impact exposure was linked to reduced sulcal depth in the left superior frontal region. However, sulcal morphology was not associated with clinical diagnosis, levels of certainty, neuropsychological test performance, or flortaucipir imaging. These findings suggest that sulcal morphology may reflect cumulative exposure to repetitive head impacts, particularly in brain regions vulnerable to chronic traumatic encephalopathy pathology. Future ante- and post-mortem validation studies are needed to determine whether sulcal morphology can serve as a reliable in vivo biomarker of risk.

Abstract Background Endoscopic placement of self-expandable metal stents (SEMS) is a minimally invasive intervention, aiming to restore luminal patency in GIT obstruction patients. As stent migration is considered a major sequela, techniques for its fixation have been established. This study aims to assess the efficacy of stent fixation using either endoscopic suture fixation or over-the-scope clips (OTSC). Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched available databases (PubMed, Scopus, and Web of Science) to identify eligible studies reported up to January 2025. Using RevMan 5.4, we reported outcomes as odds ratios (OR) and confidence intervals (CIs). A P-value ≤ 0.05 was considered statistically significant. Results Twelve studies were included in this meta-analysis, with a total of 1136 patients. The pooled OR for stent fixation is 0.32 (95% CI: 0.19–0.57; p < 0.001), with moderate heterogeneity (I² = 59%, P = 0.005). According to the subgroup analysis in relation to the fixation method, suture fixation yields a pooled OR of 0.37 (95% CI: 0.19–0.69; p = 0.002), and OTSC fixation yields a pooled OR of 0.25 (95% CI: 0.11–0.54; p = 0.0004). There is no statistically significant difference between these subgroups (p = 0.45, I² = 0%). There was no statistically significant difference in the rates of adverse events; with a pooled OR of 0.71 (95% CI: 0.33–1.54), and substantial heterogeneity (I 2 = 73%; P = 0.002). Conclusion Statistically significant lower stent migration rates were reported following either endoscopic suture fixation or OTSC, along with higher clinical success rates. Future clinical trials with longer follow-up durations are recommended to accurately update the guidelines.

Abstract Objective Gastrointestinal (GI) symptoms are common in systemic mastocytosis (SM). We hereby report the clinicopathologic and molecular features of GI mastocytosis. Methods The study includes 104 patients with suspected SM. Of 258 GI biopsy ­specimens, 33 (20 patients, 19%) were mastocytosis-positive, with 19 (16 patients) initially missed. Results Tryptase (n = 29) was weakly positive/negative in two-thirds of the mastocytosis-positive GI biopsy specimens. Additional immunohistochemistry (n = 23) showed positive mast cell expression for CD30 (n = 2), CD123 (n = 7), and PD-L1 (n = 12), as well as increased PD-1–positive cells (n = 4). Sixty patients had positive bone marrow (BM) for SM (SM-BM+), including 19 with positive GI biopsy specimens (SM-GI+). Almost all (43/44) SM-BM– patients were SM-GI–. The SM-GI vs SM-BM status showed high positive predictive value (95%) and specificity (98%). Patients with SM with mastocytosis-positive vs mastocytosis-negative GI biopsy specimens had higher serum tryptase levels (P = .04). KIT D816V mutation was detected in 7 of 13 and 12 of 13 mastocytosis-positive GI biopsy specimens using allele-specific polymerase chain reaction and droplet digital polymerase chain reaction (ddPCR), respectively. Conclusions GI mastocytosis is highly predictive of SM in BM; however, most SM-BM+ patients are SM-GI–. The SM-BM– patients are very unlikely to be SM-GI+. Because GI neoplastic mast cells are often tryptase negative, diagnostic evaluation should include CD117 and CD25 immunohistochemistry, as well as KIT D816V mutation analysis by ddPCR as needed.

Abstract Bone morphogenetic proteins ‐2 and ‐7 (BMP‐2 and BMP‐7) are effective in treating large bone defects, but the required doses are high, resulting in side effects and elevated costs. Previously, this work has demonstrated that a chemically modified messenger RNA (cmRNA) coding for BMP‐2 induced rapid and reliable healing until consolidation in a bone segmental defect in rats. Here, this work shows that the simultaneous transfer of BMP‐2 and BMP‐7 cmRNAs to stem cells leads to increased osteogenic gene expression, extracellular matrix deposition, and mineralization, compared to single or sequential delivery of these cmRNAs. Using a murine model of ectopic ossification, this work finds that dual BMP‐2/BMP‐7 cmRNA delivery using collagen‐hydroxyapatite scaffolds, designed specifically for bone repair, ensured local BMP‐2 and ‐7 expression with abundant osteogenesis in the absence of adverse effects. This confirms the superior osteogenic potency achieved by local, controlled dual delivery of cmRNAs encoding BMP‐2 and BMP‐7, further enhancing the potential of this highly translatable technology for promoting bone healing.

Clean water security demands autonomous systems that sense, reason, and act at scale. We introduce AquaSurveil, a unified multi-agent platform coupling mobile robots, fixed IoT nodes, and privacy-preserving machine learning for continent-scale water health surveillance. The architecture blends Gaussian-process mapping with distributed particle filtering, multi-agent deep-reinforcement Voronoi coverage, GAN/LSTM anomaly detection, and sheaf-theoretic data fusion; components are tuned by Bayesian optimization and governed by Age-of-Information-aware power control. Evaluated on a 2.82-million-record dataset (1940–2023; five countries), AquaSurveil achieves up to 96% spatial-coverage efficiency, an ROC-AUC of 0.96 for anomaly detection, ≈95% state-estimation accuracy, and reduced energy consumption versus randomized patrols. These results demonstrate scalable, robust, and energy-aware water quality surveillance that unifies robotics, the IoT, and modern AI.