Pilot randomised controlled trial of a culturally aligned smoking cessation app for American Indian persons.

OBJECTIVE: To pilot test QuitGuide for Natives, a culturally aligned version of the National Cancer Institute's QuitGuide smartphone app for smoking cessation. METHODS: This randomised controlled trial was conducted remotely during 2022-2023. American Indian adults who smoked and resided in the Midwest (n=115) were randomised to QuitGuide for Natives or the general audience QuitGuide smartphone-based intervention. Group differences in feasibility (times the app was initiated), usability, acceptability ('How likely would you be to recommend the app to a friend?'), fit of app with culture and preliminary efficacy (24-hour quit attempts, cotinine-confirmed self-reported 7-day abstinence) outcomes were examined. RESULTS: QuitGuide for Natives versus the general audience QuitGuide did not differ in the number of times the app was opened (adjusted incidence rate ratio 0.94 (95% CI 0.63 to 1.40); p=0.743) nor in usability score (adjusted mean difference (aMD) 0.73 (95% CI: -5.00 to 6.46); p=0.801) or likeliness of recommending the app to a friend (aMD 0.62 (95% CI -0.02 to 1.27); p=0.058). Differences were observed for all cultural fit outcomes such as 'The app fits my American Indian culture (aMD 0.75 (95% CI 0.35 to 1.16); p<0.001). QuitGuide for Natives versus the general audience QuitGuide resulted in an average of 6.6 vs 5.1 24-hour quit attempts (p=0.349) and cotinine-confirmed 7-day abstinence was achieved by 6.9% vs 3.5% (p=0.679). CONCLUSIONS: Acceptability, cultural fit and preliminary efficacy findings are encouraging and will inform future, larger-scale evaluation of culturally aligned digital smoking cessation resources for American Indian adults.

Workflow to develop 3D designed personalized neonatal CPAP masks using iPhone structured light facial scanning.

BACKGROUND: Continuous positive airway pressure (CPAP) is a common mode of respiratory support used in neonatal intensive care units. In preterm infants, nasal CPAP (nCPAP) therapy is often delivered via soft, biocompatible nasal mask suitable for long-term direct skin contact and held firmly against the face. Limited sizes of nCPAP mask contribute to mal-fitting related complications and adverse outcomes in this fragile population. We hypothesized that custom-fit nCPAP masks will improve the fit with less skin pressure and strap tension improving efficacy and reducing complications associated with nCPAP therapy in neonates. METHODS: After IRB approval and informed consent, we evaluated several methods to develop 3D facial models to test custom 3D nCPAP masks. These methods included camera-based photogrammetry, laser scanning and structured light scanning using a Bellus3D Face Camera Pro and iPhone X running either Bellus3D FaceApp for iPhone, or Heges application. This data was used to provide accurate 3D neonatal facial models. Using CAD software nCPAP inserts were designed to be placed between proprietary nCPAP mask and the model infant's face. The resulted 3D designed nCPAP mask was form fitted to the model face. Subsequently, nCPAP masks were connected to a ventilator to provide CPAP and calibrated pressure sensors and co-linear tension sensors were placed to measures skin pressure and nCPAP mask strap tension. RESULTS: Photogrammetry and laser scanning were not suited to the neonatal face. However, structured light scanning techniques produced accurate 3D neonatal facial models. Individualized nCPAP mask inserts manufactured using 3D printed molds and silicon injection were effective at decreasing surface pressure and mask strap pressure in some cases by more than 50% compared to CPAP masks without inserts. CONCLUSIONS: We found that readily available structured light scanning devices such as the iPhone X are a low cost, safe, rapid, and accurate tool to develop accurate models of preterm infant facial topography. Structured light scanning developed 3D nCPAP inserts applied to commercially available CPAP masks significantly reduced skin pressure and strap tension at clinically relevant CPAP pressures when utilized on model neonatal faces. This workflow maybe useful at producing individualized nCPAP masks for neonates reducing complications due to misfit.

Minimally invasive versus open surgery for patients undergoing intradural extramedullary spinal cord tumor resection: A systematic review and meta-analysis.

INTRODUCTION: Given the potential injury to the spinal cord and the nerve roots during the surgery and the necessity of minimal spinal cord manipulation during surgery, minimally invasive surgical techniques have emerged as alternatives to conventional open surgery in resection of ID-EM tumors. METHODS: An electronic database search was conducted, and the review was carried out according to PRISMA guidelines and recommendations. Inclusion criteria were as follows; (i) comparative studies of MIS vs OS; (ii) studies reporting outcomes for patients undergoing surgery for ID-EM tumors. Variables collected were patient demographics, estimated blood loss (EBL), mean operative time, length of stay, complications, extent of tumor resection. RESULTS: The search identified a total of 275 studies. After the selection criterion was applied 7 comparative studies were included. A total of 302 patients were included in the analysis with 149 (49.3%) of them undergoing MIS and 153 of them (50.7%) undergoing open surgery. EBL, operative time, and LOS were significantly lower in MIS group (p < 0.0001, p < 0.0001, and p = 0.0002 respectively). Two groups were similar with regards to the rates of surgical complications, medical complications and gross total resection. The most common surgical complication was CSF leak (52.3% of all complications). CONCLUSION: Results of this meta-analysis show a significant reduction in EBL, operative time, and length of stay with MIS while proving safe and preserving high rates of gross-total resection. The findings suggest that the minimally invasive spine surgery may serve as a beneficial alternative for patients undergoing spine surgery for ID-EM tumors of the spinal cord.

Three-Dimensional-Printed Liver Model Helps Learners Identify Hepatic Subsegments: A Randomized-Controlled Cross-Over Trial.

INTRODUCTION: The purpose of this study was to find out whether 3-dimensional (3D)-printed models improved the learners' ability to identify liver segments. METHODS: A total of 116 physicians from 3 disciplines were tested in a cross-over trial at baseline and after teaching with 3D models and 2-dimensional (2D) images. Adjusted multilevel-mixed models were used to compare scores at baseline and after 3D and 2D. RESULTS: Accuracy in identifying hepatic segments was higher with 3D first than 2D (77% vs 69%; P = 0.05) and not significantly improved by a combination of 3D and 2D. Increased confidence in segment identification was highest in trainees after 3D (P = 0.04). DISCUSSION: 3D-printed models facilitate learning hepatic segmental anatomy.