Evaluation of an Online Training Course for Childcare Providers Participating in the CACFP Infant Feeding Program.

INTRODUCTION: The Child and Adult Care Food Program (CACFP) provides reimbursement for meals and snacks offered in participating centers and issues nutrition standards, including guidelines for feeding infants in childcare settings. Offering training to childcare providers participating in the CACFP is necessary to ensure compliance with nutrition standards in childcare settings. METHODS: A State Department of Education and University Extension system collaborated to develop an online nutrition training course for childcare providers. Providers (n = 57) participated in the course on CACFP nutrition standards related to feeding infants (0-12 months of age). Thirty-two of 57 participants completed both pre- and post-training surveys that were used to assess changes in knowledge and confidence concerning infant feeding standards. Paired t-tests and Wilcoxon signed-rank tests were conducted to assess differences in survey responses before and after the course. RESULTS: Self-confidence and knowledge of providers related to infant feeding were significantly increased after completion of the training course (p < 0.001). More participants reported their sites were likely to respond to infants showing they were hungry or full than before the course (44.4% vs. 75.7%, respectively). Participant feedback indicated the online asynchronous course was convenient, useful, and topics were relevant to training needs. DISCUSSION: The online course was feasible and effective for providing training on CACFP guidelines for childcare providers. Feedback from participants can be adapted and used for future training programs to further improve the course and delivery methods and efficiently reach a broad audience of childcare providers.

AI-powered real-time annotations during urologic surgery: The future of training and quality metrics.

INTRODUCTION AND OBJECTIVE: Real-time artificial intelligence (AI) annotation of the surgical field has the potential to automatically extract information from surgical videos, helping to create a robust surgical atlas. This content can be used for surgical education and qualitative initiatives. We demonstrate the first use of AI in urologic robotic surgery to capture live surgical video and annotate key surgical steps and safety milestones in real-time. SUMMARY BACKGROUND DATA: While AI models possess the capability to generate automated annotations based on a collection of video images, the real-time implementation of such technology in urological robotic surgery to aid surgeon and training staff it is still pending to be studied. METHODS: We conducted an educational symposium, which broadcasted 2 live procedures, a robotic-assisted radical prostatectomy (RARP) and a robotic-assisted partial nephrectomy (RAPN). A surgical AI platform system (Theator, Palo Alto, CA) generated real-time annotations and identified operative safety milestones. This was achieved through trained algorithms, conventional video recognition, and novel Video Transfer Network technology which captures clips in full context, enabling automatic recognition and surgical mapping in real-time. RESULTS: Real-time AI annotations for procedure #1, RARP, are found in Table 1. The safety milestone annotations included the apical safety maneuver and deliberate views of structures such as the external iliac vessels and the obturator nerve. Real-time AI annotations for procedure #2, RAPN, are found in Table 1. Safety milestones included deliberate views of structures such as the gonadal vessels and the ureter. AI annotated surgical events included intraoperative ultrasound, temporary clip application and removal, hemostatic powder application, and notable hemorrhage. CONCLUSIONS: For the first time, surgical intelligence successfully showcased real-time AI annotations of 2 separate urologic robotic procedures during a live telecast. These annotations may provide the technological framework for send automatic notifications to clinical or operational stakeholders. This technology is a first step in real-time intraoperative decision support, leveraging big data to improve the quality of surgical care, potentially improve surgical outcomes, and support training and education.

Depression and anxiety among patients treated for bladder cancer: examining clinical, demographic, and psychosocial predictors.

INTRODUCTION AND OBJECTIVE: The significant impact of bladder cancer and treatment on patient health related quality of life (HRQoL) and emotional wellbeing has been documented. Increasing evidence from cancer research emphasizes the importance of examining patients supportive care needs and received social support as factors that could influence their emotional adjustment. The purpose of the study was to assess the demographic and clinical predictors of depression and anxiety among bladder cancer patients and its associations with patient reported supportive care needs and perceived availability of social support. METHODS: A cross-sectional design was used to investigate the study questions. Bladder cancer patients were recruited from the Bladder Cancer Advocacy Network (BCAN) to complete a questionnaire that included the Hospital Anxiety and Depression Scale (HADS), bladder cancer patient need survey (BCNAS-32), and the social provisions scale (SPS). The inclusion criteria restricted our sample to include bladder cancer patients who were English speakers, aged 18-85 years, and were able and willing to provide informed consent. Patients who had metastatic disease, cancer recurrence, or other primary cancers at the time of assessment were excluded from the study. RESULTS: Participants included 159 bladder cancer patients. The mean age was 62±9.4 years and 51% were male. Almost two-thirds (62%) of patients reported a diagnosis of muscle invasive bladder cancer (MIBC), 25% patient reported clinically significant levels of anxiety, 17% reported clinically significant levels of depression, and 13% and 17% reported abnormal borderline abnormal levels for anxiety and depression, respectively. Univariate regression analyses revealed significant associations between HADS total score, HADS depression and anxiety subscales, patient age, physical functioning/daily living needs, sexuality needs, and perceived social support with higher total scores, anxiety, and depression scores associated with younger age, higher unmet needs, and lower levels of social support. Multivariate regression analyses, showed similar findings confirming the associations depicted by the univariate regression analyses. CONCLUSIONS: Bladder cancer patients experience significant levels of depression and anxiety and these levels are associated with patient age, supportive care unmet needs and lack of social support. Patient focused interventions could be tailored to address these issues with the goal to improve patient HRQoL and emotional adjustment.

Examining Predictors of Nutritional Risk among Older Adults: A Needs Assessment.

Older adults are the fastest growing population in the United States. This group is at risk for developing chronic diseases resulting from high nutritional risk. The objective of this study was to assess nutritional risks and their key predictors among older adults. In this cross-sectional study, the Dietary Screening Tool, the Nutrition Self-efficacy Scale, food security, perceived health, and sociodemographics were measured. A total of 475, English-speaking adults, 50 years of age or older, residing in Maryland and attending senior congregate sites, participated in the study (urban n = 215, rural n = 260). Results showed 88.8% of participants were classified as being nutritionally 'at risk' or 'possible' risk. Higher education level, higher nutrition self-efficacy, and food security were significant predictors associated with lower nutritional risk among older adults. Implementing suitable and effective nutrition interventions requires assessing diet and identifying the needs specific to older adult populations. Utilizing appropriate screening tools is an important step in improving overall diets and may reduce barriers to adopting healthy eating behaviors in this population.

Side-specific, Microultrasound-based Nomogram for the Prediction of Extracapsular Extension in Prostate Cancer.

Background: Prediction of extracapsular extension (ECE) is essential to achieve a balance between oncologic resection and neural tissue preservation. Microultrasound (MUS) is an attractive alternative to multiparametric magnetic resonance imaging (mpMRI) in the staging scenario. Objective: To create a side-specific nomogram integrating clinicopathologic parameters and MUS findings to predict ipsilateral ECE and guide nerve sparing. Design setting and participants: Prospective data were collected from consecutive patients who underwent robotic-assisted radical prostatectomy from June 2021 to May 2022 and had preoperative MUS and mpMRI. A total of 391 patients and 612 lobes were included in the analysis. Outcome measurements and statistical analysis: ECE on surgical pathology was the primary outcome. Multivariate regression analyses were carried out to identify predictors for ECE. The resultant multivariable model's performance was visualized using the receiver-operating characteristic curve. A nomogram was developed based on the coefficients of the logit function for the MUS-based model. A decision curve analysis (DCA) was performed to assess clinical utility. Results and limitations: The areas under the receiver-operating characteristic curve (AUCs) of the MUS-based model were 81.4% and 80.9% (95% confidence interval [CI] 75.6, 84.6) after internal validation. The AUC of the mpMRI-model was also 80.9% (95% CI 77.2, 85.7). The DCA demonstrated the net clinical benefit of the MUS-based nomogram and its superiority compared with MUS and MRI alone for detecting ECE. Limitations of our study included its sample size and moderate inter-reader agreement. Conclusions: We developed a side-specific nomogram to predict ECE based on clinicopathologic variables and MUS findings. Its performance was comparable with that of a mpMRI-based model. External validation and prospective trials are required to corroborate our results. Patient summary: The integration of clinical parameters and microultrasound can predict extracapsular extension with similar results to models based on magnetic resonance imaging findings. This can be useful for tailoring the preservation of nerves during surgery.

Adjuvant Tocilizumab in the Treatment of Patients with Moderate to Severe COVID-19 Pneumonia: An Observational Study.

IMPORTANCE: As there is no definitive treatment available for covid-19 pneumonia, with timed administration of tocilizumab as an adjuvant therapy in moderate to severe covid-19 pneumonia, we can reduce mortality due to cytokine storm. OBJECTIVE: To determine effectiveness of tocilizumab as an adjuvant therapy in moderate to severe covid-19 pneumonia patients. DESIGN: Retrospective Observational study from the time period of April 2020 to December 2020. SETTING: This study has been carried out at SSG Hospital, a tertiary care hospital at Vadodara, Gujarat. PARTICIPANTS: 80 moderate to severe COVID-19 positive patients in the group of age 18-80 years requiring hospitalisation in whom tocilizumab (8mg/kg to a maximum dose of 800mg) was given, were enrolled in the study. The following patient details were collected and studied in relation to the use of tocilizumab- Biodata, Presenting complaints, past history of any illness, Drug history, Vitals and physical examination, Investigations, Treatment. Exposures: 80 patients of moderate to severe COVID-19 pneumonia who were given Injection tocilizumab (8mg/kg to a maximum dose of 800mg) were selected retrospectively. Main outcomes and Measures: We have correlated the outcome in the form of discharged or death with the help of parameters likes: Time to Clinical Improvement, Ventilator-Free Days, Duration of ICU Stay, Time to Clinical Failure, and Time to Hospital Discharge. RESULTS: Out of the total 80 patients, 29 patients were in the age group of more than 60 years, of which 7 were discharged and 22 died. The other 51 patients were less than 60 years of age, of which 28 patients were discharged and the rest 23 died. (p value 0.007). 63 patients out of the total 80 patients were males of which 31 (49.21%) recovered while 32 (50.79%) of them died. 5 (29.11%) females out of the total 17 female covid positive patients recovered while the other 12 (70.59 %) died. (p value 0.14). Conclusion and Relevance: In our study, we have observed that even after giving tocilizumab mortality was higher in patients above 60 years of age, two or more co-morbidities, SpO2 of less than 85% on the room air, SOFA scoring of more than or equal to 3, radiological involvement of more than 2 zones, higher score (>3) of inflammatory markers, higher level of mode of respiratory support like BiPAP or invasive ventilation. . This shows that the ideal time to give tocilizumab is when the patient is on NRBM support. By this it gives the maximum benefit. There was no difference in outcome in patients of either gender, blood pressure and on admission blood sugar levels, and co-administration of injection Ramdesivir. Significant percentage of patients died who had uncontrolled diabetes mellitus with insignificant p value, so further studies are required to find out the association.

FKBP1A upregulation correlates with poor prognosis and increased metastatic potential of HNSCC.

Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy globally. The etiology of HNSCC is multifactorial, including cellular stress induced by a tobacco smoking, tobacco chewing excess alcohol consumption, and human papillomavirus infection. The induction of stress includes autophagy as one of the response pathways in maintaining homeostatic equilibrium. We evaluated the expression of autophagy-related genes in HNSCC tissues from RNA sequencing datasets and identified 19 genes correlated with poor prognosis and 18 genes correlated with improved prognosis of HNSCC patients. Further analysis of independent gene expression datasets revealed that ATG12, HSP90AB1, and FKBP1A are overexpressed in HNSCC and correlate with poor prognosis, whereas the overexpression of ANXA1, FOS, and ULK3 correlates with improved prognosis. Using independent datasets, we also found that ATG12, HSP90AB1, and FKBP1A expression increased with an increase in the T-stage of HNSCC. Among all the datasets analyzed, FKBP1A was overexpressed in HNSCC and was strongly associated with lymph node metastasis in multiple in silico datasets. In conclusion, our analysis indicates dynamic alterations in autophagy genes during HNSCC and warrants further investigation, specifically on FKBP1A and its role in tumor progression and metastasis.

A formulation for suppressing bitter taste in the human oral cavity.

A model for oral drug delivery is described for diminishing bitter taste perception. This model involves the encapsulation of a bitter taste stimulus in lipid microspheres, and the subsequent incorporation of these microspheres in rapidly dissolving edible films that include both masking and flavoring agents. Stearic acid microspheres were prepared that successfully encapsulated the bitter taste stimulus sucrose octaacetate. Sucrose octaacetate microspheres were then embedded in rapidly dissolving edible films for psychophysical studies. Taste intensity, taste quality, and hedonic responses for edible taste strips that contained encapsulated sucrose octaacetate along with masking and flavoring agents in edible taste films were then obtained. These results were compared to three formulations that included either unencapsulated sucrose octaacetate in the polymer film, unencapsulated sucrose octatacetate and masking and flavoring agents in the film, or encapsulated sucrose octaacetate with no additives in the film. Of the four formulations, microsphere-containing edible films that included bitter taste masking and flavoring agents masked the bitter taste of sucrose octaacetate most effectively over a 60-second time period. Participants also reported favorable (positive) hedonic responses with this formulation. The encapsulation of bitter taste stimuli in lipid microspheres and incorporating these microspheres in rapidly dissolving edible films that contain masking and flavoring agents, significantly decreased bitter taste perception. This approach is a promising mechanism for masking bitter taste perception and may represent a model for increasing drug acceptance and drug compliance in both the young and the elderly.

Effect of backpack loading on cervical and sagittal shoulder posture in standing and after dynamic activity in school going children.

BACKGROUND: Adolescent age group as school going children who experience a period of accelerated growth and development of skeletal and soft tissue. Any daily physical stresses external forces such as load carrying may also influence alignment of the human body. It is assumed that daily intermittent abnormal postural adaptations could result in pain and disability. OBJECTIVES: To know the effect of backpack loading on cervical and sagittal shoulder posture (SSP) in standing and after dynamic activity in school going children. MATERIALS AND METHODS: The research project was conducted after getting clearance from Human Research Ethics Committee of the H M Patel Institution for Education and research center. Study was conducted on 160 school going children, and measurement were taken to know the loading over the cervical region along with their bagpacks were weighed. RESULTS: Total 160 students were enrolled in the present study. Study found that average value of the subject's body weight was 34.83 kg, and subjects backpack weight was 6.42 kg that was equivalent to 18% of the subject's body weight. The mean value of cranio-vertebral angle (CVA) without school bag was 40.62. The mean values of cranio-horizontal angle (CHA) while standing with 18% of body weight and after dynamic activities with 18% of body weight were 24.51 ± 10.3 and 28.93 ± 4.34, respectively. The mean value of SSP without school bag was 39.39 ± 4.31, whereas the mean values of SSP while standing with 18% of body weight and after dynamic activities with 18% of body weight were 54.38 ± 21.19 and 77.62 ± 17.50, respectively. CONCLUSIONS: Study revealed that there is a significant reduction in the CVA (or increased forward head position), increase in CHA, and SSP were found while carrying a backpack weight 18% of body weight over both shoulders.

Pustular DRESS Syndrome Secondary to Hydroxychloroquine With EBV Reactivation

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome) or drug-induced hypersensitivity (DIHS) is a rare and feared complication of frequently used medications such as anticonvulsants, sulfonamides, and allopurinol. To date, no reports of hydroxychloroquine-induced pustular DRESS syndrome have been associated with Epstein-Barr virus (EBV) reactivation nor imitated other cutaneous adverse drug reactions as in our patient. Observation: A 56-year-old female presented with a diffuse cutaneous eruption involving the face, trunk, extremities, and palms approximately two weeks after the initiation of hydroxychloroquine therapy for a suspected Sjögren's-like process with inflammatory cervical lymphadenopathy. Skin examination demonstrated diffuse erythematous and edematous papules and pustules on her dorsal and volar hands and fingers, arms, legs, chest, abdomen, back, scalp, and face. In many areas, lesions coalesced into plaques with overlying pustules, scale, and crust. Additional notable exam findings included centralized facial edema, edema of the hands, and cervical lymphadenopathy. Laboratory workup revealed leukocytosis, peripheral eosinophilia, elevated transaminases, and a negative autoimmune workup; however, serology demonstrated EBV reactivation. Histologic assessment displayed a spongiotic dermatitis with eosinophils, superficial perivascular dermatitis, as well as corneal, subcorneal, and intraepidermal neutrophilic microabscesses, mimicking acute generalized exanthematous pustulosis or pustular psoriasis, even though clinical evaluation suggested DRESS syndrome. Conclusion: To our knowledge, this is the first reported case of hydroxychloroquine-induced pustular DRESS syndrome in the context of EBV reactivation. Given hydroxychloroquine's immunomodulatory function and association with other cutaneous manifestations, our patient represents a significant diagnostic challenge. Therefore, this case highlights the importance of knowledge regarding overlapping features, histologically and clinically, among acute generalized exanthematous pustulosis, pustular psoriasis, and DRESS syndrome. J Drugs Dermatol. 2019;18(2):207-209.

Spectroscopic and Electrochemical Properties of Electronically Modified Cycloplatinated Formazanate Complexes.

Formazanates are a class of monoanionic, chromophoric, redox-active chelating ligands, and until recently, the coordination chemistry of formazanates with third-row transition metals was unexplored. Described here is a series of heteroleptic cyclometalated platinum formazanate complexes of the type Pt(C^N)(Fz), where "C^N" is the cyclometalating ligand and "Fz" is the formazanate. This work includes a set of 14 complexes derived from four different cyclometalating ligands and five different formazans, greatly expanding the structural and electronic diversity of this class of complexes. The formazans fall into two major categories: triarylformazans with either electron-donating (Me, OMe) or electron-withdrawing (CN) para substituents, and even more electron-deficient diarylformazans where the center position of the backbone is a cyano group. Seven of the new compounds are characterized by single-crystal X-ray diffraction, and all are characterized by cyclic voltammetry and UV-vis absorption spectroscopy to provide insight into the frontier orbitals. The complexes can be electrochemically reduced by three electrons, with the first two electrons populating formazanate-centered frontier orbitals and the third being added to the Pt-C^N fragment. The formazanate-based reduction potentials are highly sensitive to the substitution pattern of the formazanate and can be tuned over a wide range of ca. 0.8 V by altering substituents. The formazanates also impart these complexes with very strong, low-energy visible absorption bands assigned to HOMO → LUMO transitions, which are greatly perturbed from the free ligand due to interactions of the formazanate frontier orbitals with platinum-centered orbitals. Unlike the redox properties, the formazanate-derived visible absorption band is relatively insensitive to substituent effects. Additional visible absorption bands, attributed to Pt(d) → C^N(π*) MLCT transitions, can be tuned over a wide range by changing the structure of the C^N ligand, giving rise to strong panchromatic absorption for some members of the series.

Miniature forward-viewing common-path OCT probe for imaging the renal pelvis.

We demonstrate an ultrathin flexible cone-scanning forward-viewing OCT probe which can fit through the working channel of a flexible ureteroscope for renal pelvis imaging. The probe is fabricated by splicing a 200 µm section of core-less fiber and a 150 µm section of gradient-index (GRIN) fiber to the end of a single mode (SM) fiber. The probe is designed for common-path OCT imaging where the back-reflection of the GRIN fiber/air interface is used as the reference signal. Optimum sensitivity was achieved with a 2 degree polished probe tip. A correlation algorithm was used to correct image distortion caused by non-uniform rotation of the probe. The probe is demonstrated by imaging human skin in vivo and porcine renal pelvis ex vivo and is suitable for imaging the renal pelvis in vivo for cancer staging.

Food preferences of older adults in senior nutrition programs.

The Elderly Nutrition Program (ENP) is being challenged to improve the quality of meal programs. The purpose of this study was to explore how food preferences varied depending on gender and ethnic groups. A total of 2,024 participants in the ENP aged 60 years or older were interviewed. A majority of the participants were female (74.7%), served by congregate meal programs (71.7%), with the mean ± SD age of 76.9 ± 9.2 years. A general impression of the meals and preferences for 13 food groups (fresh fruit, chicken, soup, salad, vegetables, potatoes, meat, sandwiches, pasta, canned fruit, legumes, deli meats, and ethnic foods) were assessed. After adjusting other variables, older males were significantly more likely to prefer deli meats, meat, legumes, canned fruit, and ethnic foods compared to females. In addition, compared with African Americans, Caucasians demonstrated higher percentages of preference for 9 of 13 food groups including pasta, meat, and fresh fruit. To improve the quality of the ENP, and to increase dietary compliance of the older adults to the programs, the nutritional services require a strategic meal plan that solicits and incorporates older adults' food preferences.

A Single Surgeon's Experience with Open, Laparoscopic, and Robotic Partial Nephrectomy.

Objective. To report the perioperative outcomes of patients treated with partial nephrectomy by a single surgeon using three surgical modalities-open, laparoscopic, and robotic. Methods. Between August 2006 and February 2012, 106 consecutive patients underwent open partial nephrectomy (OPN) (n = 23), laparoscopic partial nephrectomy (LPN) (n = 48), and robotic partial nephrectomy (RPN) (n = 35) by a single surgeon. Clinical variables, operative parameters, and renal functional outcomes were analyzed. Results. Preoperative patient characteristics were similar except for baseline glomerular filtration rate (GFR), which was highest in the RPN group (P = 0.004). Surgery time was longest in the RPN group (244 minutes) and shortest in the OPN group (163 minutes, P < 0.0001). Patients who had OPN had the highest incidence of 30-day complications (30%), while the RPN approach had the lowest (14%, P = 0.008). Conclusions. When performed by a single surgeon, robotic partial nephrectomy appears to be associated with fewer complications than both open and laparoscopic partial nephrectomy. Kidney function was not affected by surgical approach.

Chronic epithelial kidney injury molecule-1 expression causes murine kidney fibrosis.

Acute kidney injury predisposes patients to the development of both chronic kidney disease and end-stage renal failure, but the molecular details underlying this important clinical association remain obscure. We report that kidney injury molecule-1 (KIM-1), an epithelial phosphatidylserine receptor expressed transiently after acute injury and chronically in fibrotic renal disease, promotes kidney fibrosis. Conditional expression of KIM-1 in renal epithelial cells (Kim1(RECtg)) in the absence of an injury stimulus resulted in focal epithelial vacuolization at birth, but otherwise normal tubule histology and kidney function. By 4 weeks of age, Kim1(RECtg) mice developed spontaneous and progressive interstitial kidney inflammation with fibrosis, leading to renal failure with anemia, proteinuria, hyperphosphatemia, hypertension, cardiac hypertrophy, and death, analogous to progressive kidney disease in humans. Kim1(RECtg) kidneys had elevated expression of proinflammatory monocyte chemotactic protein-1 (MCP-1) at early time points. Heterologous expression of KIM-1 in an immortalized proximal tubule cell line triggered MCP-1 secretion and increased MCP-1-dependent macrophage chemotaxis. In mice expressing a mutant, truncated KIM-1 polypeptide, experimental kidney fibrosis was ameliorated with reduced levels of MCP-1, consistent with a profibrotic role for native KIM-1. Thus, sustained KIM-1 expression promotes kidney fibrosis and provides a link between acute and recurrent injury with progressive chronic kidney disease.