Recent uci items

The Evolving Landscape of Systemic Therapy for Liposarcoma.

Thu, 18 Jun 2026 00:00:00 +0000

Background/objectives

Liposarcoma represents a heterogeneous group of mesenchymal malignancies with distinct molecular profiles and clinical behaviors. While localized disease is managed with surgical resection, advanced or metastatic liposarcoma poses a significant therapeutic challenge due to limited response to traditional cytotoxic chemotherapy. This review summarizes current evidence-based systemic therapies and highlights recent advances in subtype-driven treatment strategies.

Methods

We review key clinical trials supporting the use of anthracycline regimens, trabectedin, eribulin, and nuclear export inhibition with selinexor, as well as emerging targeted approaches directed at MDM2 and CDK4 amplification. In addition, we discuss the evolving role of immunotherapy, including checkpoint inhibitors and engineered T-cell receptor therapies targeting cancer-testis antigens.

Results

Integrating molecular biology with therapeutic development, we emphasize...

What Explains the Relations Between Reading Comprehension and Written Composition? Findings from a Longitudinal Study

Thu, 18 Jun 2026 00:00:00 +0000

This study investigated the relation between reading comprehension and written composition in Grade 2, as well as how language and literacy skills explain this connection. Additionally, it explored how kindergarten language, cognitive, and literacy skills relate to Grade 2 reading comprehension and written composition through Grade 2 language and literacy skills. The study followed 261 English-speaking students (55% boys) from kindergarten through grade 2 in the US. The sample’s racial composition in kindergarten was 53% white, 33% African American, 3% Hispanic, and 5% mixed race. Grade 2 skills included reading comprehension, written composition, oral discourse skills, lexical literacy skills, and handwriting fluency. Kindergarten assessments covered a broader range of language, cognitive, and literacy skills. Confirmatory factor analysis revealed a strong correlation (.82) between reading comprehension and written composition. Structural equation modeling showed that grade 2...

Understanding the Impacts of Telecommuting on Travel Behavior Before, During, and After the Pandemic

Thu, 18 Jun 2026 00:00:00 +0000

California set ambitious goals for decarbonizing the transportation sector, including reducing the amount of per capita vehicle travel. This may mean shifting more travel to other modes of travel, such as ride-hailing (i.e., on-demand services such as Uber, Lyft, and taxis) and public transit. To better understand different types of non-automobile travelers, we examined the connections between the tour-based travel patterns of public transit and ride-hailing users and their household activities . Our analysis used an activity-based approach that considers daily travel patterns using tours and activity patterns as basic units of analysis. We identified different subgroups or “classes” of riders based on the type of trips taken and modes used and then analyzed the socio-demographic composition of each class. All tours considered in our study start and end at home, with at least one trip by ride-hail or transit. Additionally, tours were classified as work or non-work trips, and complex...

Learning to Read in Korean: An Application of the Direct and Indirect Effect Model of Reading (DIER)

Thu, 18 Jun 2026 00:00:00 +0000

In this chapter I introduce the Direct and Indirect Effect Model of Reading (DIER), an integrative theoretical framework designed to explain reading development across languages, and examine its application in Korean. DIER posits that successful reading comprehension relies on a multitude of interdependent skills and knowledge, including executive functions, orthography, phonology, morphology, vocabulary, grammatical knowledge, higher-order cognitive abilities, background knowledge, and socio-emotional aspects. A review of evidence from Korean-speaking children supports the model's component skills hypothesis and hierarchical relations hypothesis. Despite substantial research on reading development in Korean, however, gaps also remain, particularly in understanding text-level reading and the structural relations among component skills. I also discuss the implications of DIER for assessment and teaching, emphasizing the need for targeted, integrated instruction tailored to individual...

The Associations of Social Engagement with Cognitive and Physical Health in American Indian and Alaska Native Adults

Thu, 18 Jun 2026 00:00:00 +0000

AbstractBackground

Research on social engagement, community connectedness, and health outcomes in American Indian and Alaska Native (AI/AN) adults is limited. This study examined associations of social engagement and community overlap with cognitive function, distress, and mental and physical health in middle‐aged and older AI/AN adults.

Method

Data were collected from a cross‐sectional survey conducted from 2019‐2023 among urban and rural AI/AN volunteers aged 45+ years residing in the Rocky Mountain area. Social engagement was measured using a five‐item social frequency instrument, and community overlap was assessed using the Inclusion of Community in Self scale. Health outcomes included the number of “Yes” responses to culturally tailored Ascertain Dementia 8‐item Questionnaire (i.e., AD8 scores), distress measured by the Kessler Psychological Distress Scale (K6), and self‐reported mental and physical health. Mental and physical health assessments were based on a four‐point...

Changes in Type 2 Diabetes Medications Among Primary Care Patients After California's 2022 Medicaid Expansion.

Thu, 18 Jun 2026 00:00:00 +0000

OBJECTIVE: In May 2022, California expanded full-scope Medicaid (Medi-Cal) to low-income undocumented immigrants aged 50 years or older, which provided access to newer type 2 diabetes (T2D) medications. This study examined whether the expansion led to more prescriptions of newer therapies like glucagon-like peptide 1 receptor agonists and sodium-glucose cotransporter 2 inhibitors among older undocumented immigrants. RESEARCH DESIGN AND METHODS: We used patient records between January 2019 to June 2023 from two Federally Qualified Health Centers (FQHCs) in Los Angeles County. We compared prescriptions among 1) older undocumented immigrants newly eligible for Medi-Cal, 2) younger undocumented immigrants not eligible for Medi-Cal, and 3) documented patients (n = 20,420 encounters and 4,601 patients). We used generalized linear mixed models with patient-level random intercepts to examine whether the patient groups differed in their likelihood of being prescribed newer medications...

SCREENING FOR EARLY LIFE UNPREDICTABILITY IN PEDIATRIC PRIMARY CARE IDENTIFIES CHILD OBESITY RISK

Thu, 18 Jun 2026 00:00:00 +0000

SCREENING FOR EARLY LIFE UNPREDICTABILITY IN PEDIATRIC PRIMARY CARE IDENTIFIES CHILD OBESITY RISK

Mismatch between the eye and the optic lobe in the giant squid.

Thu, 18 Jun 2026 00:00:00 +0000

Giant squids (Architeuthis) are a legendary species among the cephalopods. They live in the deep sea and are well known for their enormous body and giant eyes. It has been suggested that their giant eyes are not adapted for the detection of either mates or prey at distance, but rather are best suited for monitoring very large predators, such as sperm whales, at distances exceeding 120 m and at a depth below 600 m (Nilsson et al. 2012 Curr. Biol.22, 683-688. (doi:10.1016/j.cub.2012.02.031)). However, it is not clear how the brain of giant squids processes visual information. In this study, the optic lobe of a giant squid (Architeuthis dux, male, mantle length 89 cm), which was caught by local fishermen off the northeastern coast of Taiwan, was scanned using high-resolution magnetic resonance imaging in order to examine its internal structure. It was evident that the volume ratio of the optic lobe to the eye in the giant squid is much smaller...

Developmental relations of Spanish and English spelling in emergent bilinguals between grade 1 and grade 3: exploring scoring methods and instructional contexts

Thu, 18 Jun 2026 00:00:00 +0000

This study aimed to enhance our understanding of Spanish-English emergent bilingual children's spelling development by examining the relation between their spelling skills in both languages over time. We also investigated two different scoring methods for spelling and how the language of instruction influenced these relations. The study included 209 Spanish-English bilingual children in the U.S. assessed in Grades 1 and 3. Results showed that children's spelling performance in Spanish and English significantly differed depending on their instructional programs. Using correctness scores, Spanish spelling positively predicted later English spelling, whereas English spelling showed an initial negative relation to future Spanish spelling. This negative relation was not observed when text distance scores were used or when instructional program was explicitly modeled, suggesting the initial negative finding likely reflected measurement limitations in correctness scoring and instructional...

Structured Spatial Reliability Modeling and Harmonic Waveform Analysis in Remote Photoplethysmography

Thu, 18 Jun 2026 00:00:00 +0000

Remote photoplethysmography (rPPG) enables non-contact cardiovascular monitoring by recovering physiological pulse signals directly from facial videos. Although recent deep learning and signal-processing approaches have demonstrated increasingly competitive heart-rate estimation performance, robust physiological waveform recovery under unconstrained motion and pose variation remains a significant challenge. Existing methods frequently emphasize aggregate cardiac frequency estimation while overlooking the preservation of detailed physiological waveform structure and the spatial reliability degradation induced by head movement. This thesis investigates remote physiological estimation from two complementary perspectives. First, the spectral and harmonic structure of remotely recovered physiological signals is analyzed to study the extent to which pulse-wave morphology can be reconstructed from facial videos. A harmonic representation framework is introduced to characterize...

Can California Power Electric Construction Equipment at Scale?

Thu, 18 Jun 2026 00:00:00 +0000

California’s climate policies are accelerating the transition to zero-emission vehicles, but the construction sector faces a major barrier: access to reliable power at job sites. While electric excavators and loaders are entering the market, many construction sites—often temporary and in remote or constrained locations—lack the electrical infrastructure needed to support them. Grid connections are often too costly and take too long to install for construction projects, and existing grid infrastructure was not designed to handle the power demand of heavy machinery. Without practical charging solutions, electrifying the construction sector may lag behind state goals. Meanwhile, construction equipment is contributing 1% to 2% of California’s total greenhouse gas emissions.To better understand these challenges, we reviewed existing research, assessed available charging technologies, and spoke with utilities and energy providers across California. We focused on identifying key barriers...

A Review of Pricing Strategies for Decarbonizing Transportation

Thu, 18 Jun 2026 00:00:00 +0000

California’s ability to achieve its climate and mobility goals depends on addressing the growing gap between transportation infrastructure needs and the declining effectiveness of traditional fuel tax revenues. As electric vehicle adoption rises, fuel efficiency improves, and demands for resilient, multimodal systems expand, new approaches to transportation funding and demand management are required. This paper examines a range of mobility pricing strategies—including tolling, managed lanes, congestion charges, vehicle-based fees and feebates, distance-based user charges, and parking pricing—to evaluate their potential for enhancing financial sustainability, reducing congestion, and internalizing the environmental and social costs of driving. Particular attention is given to dynamic pricing, which can flexibly manage demand for both road and parking space, and to distance-based charges that offer a more equitable and efficient alternative to fuel taxes. The analysis highlights...

Young‐Onset Dementia in Medicare Beneficiaries: Prevalence and Comorbidities by Race and Ethnicity

Thu, 18 Jun 2026 00:00:00 +0000

AbstractBackground

Young‐onset dementia (YOD), which develops before age 65, can bring additional challenges to patients and their caregivers. The prevalence of YOD and its associated comorbidities across U.S. racial/ethnic populations remain unclear. Thus, this study aimed to estimate the prevalence of YOD and examine associations between past and current comorbidities (called comorbidities hereafter) and YOD among Medicare beneficiaries in various racial/ethnic groups.

Method

This cross‐sectional study included Medicare beneficiaries aged 45‐64 years with almost‐continuous fee‐for‐service coverage in 2022. Data were extracted from the Center for Medicare and Medicaid Services 2022 Medicare Beneficiary Summary File (MBSF). MBSF race/ethnicity data were used to identify non‐Hispanic White (White), non‐Hispanic Black (Black), Hispanic, non‐Hispanic Asian (Asian), and non‐Hispanic American Indian and Alaska Native (AI/AN) populations. Comorbidities examined include diabetes,...

Computed tomography staging of colon cancer: improved patient selection for neoadjuvant therapy with combined radiologic tumor and nodal staging.

Thu, 18 Jun 2026 00:00:00 +0000

BACKGROUND: Patient selection for neoadjuvant therapy in colon cancer (CC) needs to be improved as utilizing computed tomography (CT) tumor (T) staging alone is associated with overstaging and overtreatment. Therefore, we sought to identify specific nodal imaging features that can be combined with radiologic T staging to improve patient selection. METHODS: Pre-operative CTs of stage I-III CC patients treated with upfront resection (2018–2023) were assessed by an expert abdominal radiologist blinded to the histopathologic staging. Radiologic T and node (N) staging based on five imaging features (single lymph node (LN) > 1 cm, ≥ 3 prominent LNs, irregular borders, heterogenous enhancement, and extramural venous invasion) were compared to the pathologic staging, grouped by proficient or deficient mismatch repair status (pMMR vs. dMMR). RESULTS: Of the 177 patients, 147 and 30 had pMMR and dMMR CC, respectively. The overstaging rate for pathologic T staging was 6.1% pMMR vs....

Neural Organization of the Optic Lobe Changes Steadily from Late Embryonic Stage to Adulthood in Cuttlefish Sepia pharaonis.

Thu, 18 Jun 2026 00:00:00 +0000

The optic lobe is the largest structure in the cuttlefish brain. While the general morphology of the optic lobe in adult cuttlefish has been well described, the 3D structure and ontogenetic development of its neural organization have not been characterized. To correlate observed behavioral changes within the brain structure along the development of this animal, optic lobes from the late embryonic stage to adulthood were examined systematically in the present study. The MRI scan revealed that the so called cell islands in the medulla of the cephalopods optic lobe (Young, 1962, 1974) are in fact a contiguous tree-like structure. Quantification of the neural organizational development of optic lobes showed that structural features of the cortex and radial column zone were established earlier than those of the tangential zone during embryonic and post-hatching stages. Within the cell islands, the density of nuclei was decreased while the size of nuclei was increased during the development....

Language Variation in Elementary Students’ Writing

Thu, 18 Jun 2026 00:00:00 +0000

Language varieties such as African American English and Southern American English are well-established dialects of English with historic importance and modern cultural capital. While features of language varieties, such as nonmainstream dialects, are well documented in children’s spoken language, less has been studied about child dialect speakers’ writing in academic settings. In this study, we explored the features and frequency of use of African American English and Southern American English in a sample of 250 second- and third-grade students located in the southeastern part of the US. We analyzed and compared nonmainstream dialect production in an oral narrative task and between 2 different written language samples, one elicited by a narrative prompt and the other by an expository prompt. Importantly, we discuss implications for teachers and other practitioners to consider when working with diverse students.

Cognitive Impairment and Its Associated Comorbidities in American Indian and Alaska Native Communities

Thu, 18 Jun 2026 00:00:00 +0000

AbstractBackground

Relationships between comorbidities and cognitive impairment among American Indian and Alaska Native (AI/AN) adults remain unclear. This study explored the proportion of cognitive impairment and its association with various comorbidities in AI/AN communities across different age groups.

Method

In 2019, a cross‐sectional survey was conducted among AI/AN volunteers aged 45+ residing in urban and rural areas across the Pacific Northwest, Rocky Mountains, and Northern Plains. Data on demographics, responses to culturally tailored Ascertain Dementia 8‐item Questionnaire (AD8), and self‐reported medical history of comorbidities were collected. Comorbidities included distress, diabetes, hypertension, heart disease, stroke, head injury, alcohol use disorder, and obesity. Cognitive impairment was defined as answering “Yes” to 2 or more AD8 questions, with the total number of “Yes” responses counted as the AD8 score. Higher AD8 scores indicate poorer cognitive...

Limbic‐predominant age‐related TDP‐43 encephalopathy, but Not Alzheimer's Disease, neuropathological changes are associated with Physical Performance Decline in the Oldest Old: Insights from The 90+ Study

Thu, 18 Jun 2026 00:00:00 +0000

AbstractBackground

To examine physical performance longitudinal trajectories in relation to Alzheimer's Disease Neuropathological Changes (ADNC) and Limbic‐predominant age‐related TDP‐43 encephalopathy neuropathological changes (LATE‐NC) at autopsy. ADNC and LATE‐NC have similar cognitive presentations, but it is unclear whether physical presentation is similar as well.

Method

Participants were from The 90+ Study, a longitudinal study of aging among individuals 90 years and older with evaluations every 6 months. We used 4 physical performance measures including gait speed, the Five Times Sit to Stand test (5XSST), grip strength, balance, and a composite summing the 4 measures. Each measure was scored from 0 (unable to perform) to 4 (best performance), the composite from 0 to 16. Neuropathological changes from brain autopsies were dichotomized: ADNC as intermediate/high versus none/low and LATE‐NC as present versus absent. To examine the longitudinal association of ADNC...

Alzheimer's Disease and Related Dementia and Related Health Conditions Among American Indian and Alaska Native Medicare Beneficiaries

Thu, 18 Jun 2026 00:00:00 +0000

AbstractBackground

American Indian and Alaska Native (AI/AN) peoples face a rising burden of Alzheimer's disease and related dementia (ADRD). The 2024 Lancet Commission identified modifiable risk factors for dementia for the general population; however, a comprehensive understanding of risk factors associated with ADRD among AI/AN peoples is missing. This study utilizes a national database to estimate the prevalence of health conditions associated with ADRD and examine disparities between older AI/AN and White populations.

Method

We analyzed 2019 Medicare Master Beneficiary Summary File data for Medicare beneficiaries aged 68 and older, including all AI/AN beneficiaries and a 5% random sample of White beneficiaries. Two types of health conditions were examined: Lancet risk factors available in the Medicare data and other conditions that have been associated with ADRD (Table 1). Prevalence of ADRD and each condition was reported. Bivariate and multivariate logistic regressions...

ESPRESSO: Spatiotemporal omics based on organelle phenotyping reveals dynamic cell state transitions

Wed, 17 Jun 2026 00:00:00 +0000

ESPRESSO: Spatiotemporal omics based on organelle phenotyping reveals dynamic cell state transitions

Investigating How Social and Physical Distance Impact Offender and Victim Mobility with Discrete Choice Modeling

Wed, 17 Jun 2026 00:00:00 +0000

Objectives: This study assesses how physical and social distances influence locational choice decision-making across six crime types—burglary, larceny, vehicle theft, assault offense, robbery, and drug violations. It aims to identify how physical distance and social distance affect locational choices in offending and the exposure patterns underlying victimization, while comparing offender and victim mobility across different crime types. Methods: Employing a discrete choice modeling (DCM) framework, this analysis uses 341,804 police incident entries and 40,228 police arrest records from Dallas, covering 2014-06-01 to 2020-03-23. Data integrated from the 2010 Census and American Community Survey 5-year estimates are analyzed at the census block group level, controlling for features of target block groups. Results: Both offender and victim mobility exhibit clear distance decay patterns, with higher physical distances significantly reducing the likelihood of crime involvement in...

Plasma p-tau217, p-tau181, and Aβ42 predict amyloid PET positivity in cognitively unimpaired adults.

Wed, 17 Jun 2026 00:00:00 +0000

Background

Early detection of Alzheimers disease (AD) pathology in cognitively unimpaired individuals is critical for preclinical intervention. Plasma biomarkers, especially phosphorylated tau217 (p-tau217), are promising predictors of amyloid-β (Aβ) accumulation.

Methods

In this cohort study, we analyzed data from cognitively unimpaired older adults in the A4 and LEARN studies (n = 1,407), comprising 452 participants with Aβ positron emission tomography (PET)-negative status and 955 participants with Aβ PET-positive status. We evaluated the accuracy of plasma biomarkers (p-tau217, p-tau181, Aβ42/40 ratio, and others) in predicting Aβ PET positivity using receiver operating characteristic analysis, comparing covariate-adjusted individual biomarker and biomarker-ratio models with a multivariable combined model integrating plasma biomarkers and covariates. (age, sex, apolipoprotein E [APOE] ε4 genotype).

Results

Plasma p-tau217 showed the strongest individual...

The Problematic Rhetoric of a "Rules-Based International Order" and Selective Support for Proceedings Before International Courts

Wed, 17 Jun 2026 00:00:00 +0000

The Problematic Rhetoric of a "Rules-Based International Order" and Selective Support for Proceedings Before International Courts

USP7 inhibition perturbs proteostasis and tumorigenesis in triple-negative breast cancer

Wed, 17 Jun 2026 00:00:00 +0000

The deubiquitinase USP7 is a critical regulator of tumorigenesis, known for stabilizing the MDM2-p53 pathway. Emerging evidence highlights USP7’s p53-independent roles in proliferation and tumorigenesis. Our study reveals that USP7 is broadly upregulated in breast cancer, including triple-negative breast cancer (TNBC), a subtype characterized by near-universal TP53 loss. This provides a model to investigate p53-independent functions of USP7. Using TNBC models, we define p53-independent roles of USP7 in regulating proteostasis and tumorigenesis. Importantly, genetic and pharmacologic USP7 inactivation impaired tumor progression in TNBC models. To explore USP7’s role in p53-mutant TNBCs, we performed deep quantitative proteomics across TNBC cell lines, identifying shared USP7 targets involved in cell proliferation, genome stability, and proteostasis. Acute USP7 inactivation allowed us to infer proximally controlled proteins that are likely direct targets. Surprisingly, many of the...

We Need Granular Sharing of De-Identified Data—But Will Patients Engage? Investigating Health System Leaders' and Patients' Perspectives on A Patient-Controlled Data-Sharing Platform

Wed, 17 Jun 2026 00:00:00 +0000

Patient-controlled data-sharing systems are increasingly promoted as a way to empower patients with greater autonomy over their health data. Yet it remains unclear how different stakeholders, especially patients and health system leaders, perceive the benefits and challenges of enabling granular control over the sharing of de-identified medical data for research. To address this gap, we developed a high-fidelity prototype of a patient-controlled, web-based consent platform and conducted a two-phase mixed-methods study: semi-structured interviews with 16 health system leaders and a survey with 523 patient participants. While both groups appreciated the potential of such a platform to enhance transparency and autonomy, their views diverged in meaningful ways. Leaders viewed transparency and granular control through the lens of informed consent and institutional ethics, whereas patients interpreted these factors as safeguards against potential risks and uncertainties. Our findings...

Wildfire and Smoke Risk Communication: A Systematic Literature Review from a Health Equity Focus

Wed, 17 Jun 2026 00:00:00 +0000

Effective wildfire smoke risk and evacuation communication is urgently needed to avert unnecessary deaths as wildfires increase in frequency and intensity. Human exposure to wildfires has doubled in the last two decades. Low-income, marginalized communities are the most disadvantaged in their ability to respond. A systematic literature review of wildfire and wildfire smoke risk communication research between 2014 and 2024 was conducted. Web of Science and Scopus databases were searched using the keywords "wildfire", "communication", "wildfire smoke", "risk", and "public health", resulting in 23 studies. The findings revealed marginalized communities were ill-prepared to respond to wildfires and take protective action against wildfire smoke. The findings were summarized across eight areas: the needs of marginalized communities to respond to wildfires, the role of trusted messengers to disseminate wildfire and smoke risk messaging, using diverse channels, timing and frequency considerations...

The New Alternative to a Narrowing Alien Tort Statute: Torts Based on Foreign Law

Wed, 17 Jun 2026 00:00:00 +0000

The New Alternative to a Narrowing Alien Tort Statute: Torts Based on Foreign Law

Is International Human Rights Law Accessible and Effective for American Civil Society? Insights from NGO Participation in the 2023 Human Rights Committee Review

Wed, 17 Jun 2026 00:00:00 +0000

This research assesses the access and effectiveness of International Human Rights Law (IHRL) use by U.S. civil society, particularly in light of the 2023 Human Rights Committee review. Recognizing the pivotal role of civil society in leveraging IHRL to influence domestic laws and policies, the study shifts focus from the current limitations of IHRL on domestic policy influence in the United States to the actual and potential use of IHRL by the American civil society.

Through a combination of desk research and semi-structured interviews with 20 representatives from Non-Governmental Organizations (NGO) and law school clinicians who participated in the 2023 Human Rights Committee’s review of the United States, the study identifies key factors influencing access and effectiveness. While the research confirms that overall appreciation of IHRL among interviewees, the findings reveal awareness gaps regarding IHRL’s utility for the U.S. civil society as a whole. Resource...

Trauma-Informed Lawyering Leads to Movement Lawyering in International Human Rights Work

Wed, 17 Jun 2026 00:00:00 +0000

Trauma-Informed Lawyering Leads to Movement Lawyering in International Human Rights Work

Male reproductive biology was reshaped during placental mammal diversification through epididymal secretome expansion.

Wed, 17 Jun 2026 00:00:00 +0000

The evolutionary timing of the origin of secretory proteins underlying post-mating reproductive processes remains uncharacterized in vertebrates. We dated the origin of 2520 human tissue-specific genes encoding secretory proteins across vertebrate evolution, finding that the male reproductive (MR) secretome underwent a dramatic expansion during the eutherian (placental mammal) diversification, experiencing a 6.8-fold gene gain-the largest increase compared to any other secretome or transition in vertebrate evolution. These genes are predominantly expressed in the epididymis, where they protect sperm and drive sperm maturation, influencing essential post-mating reproductive processes and male reproductive outcome. In contrast, MR secretome genes that originated along other evolutionary branches are primarily associated with sperm structure, motility, egg binding, and fusion. These findings provide molecular evidence for a major reconfiguration of male reproductive biology during...

The distinct trimeric structure of the immunodominant chlamydial antigen Major Outer Membrane Protein.

Wed, 17 Jun 2026 00:00:00 +0000

The chlamydial Major Outer Membrane Protein (MOMP) is a promising subunit vaccine candidate due to its abundance in the outer membrane (OM), the presence of four surface-exposed variable domains (VDs) containing neutralizing and serotyping epitopes, and confirmed T-cell epitopes located in its constant domains (CDs). However, recombinant and denatured forms of MOMP have failed to elicit immune responses comparable to native preparations, indicating that conformation is critical for immunogenicity. Here, we present two cryo-EM structures of native Chlamydia muridarum MOMP, isolated from infectious elementary bodies (EBs). EB MOMP forms a distinct trimer with a stem of three narrow, non-permeable β-barrels and an extracellular, folded antigenic cap that displays VDs. In complex with a neutralizing Fab fragment of a conformational antibody, the cap undergoes structural reorganization that shows how epitope presentation is modulated by immune engagement. These structures reveal the...

Can International Law Thrive In the United States: Questions on the Use of Force

Wed, 17 Jun 2026 00:00:00 +0000

Today’s symposium asks whether international law can thrive in the United States. The question is intriguing but also ambiguous, and it is not immediately clear what it would mean for international law to “thrive” within a state. One might look to a range of possible indicators, including the extent to which international law is internalized in U.S. domestic law, its participation in treaty regimes, its willingness to submit disputes to international adjudication, or the prominence of international law issues in public discourse and government decision-making on important foreign policy matters. For purposes of this presentation, however, I focus on one concrete indicator: the extent to which the United States complies with international legal obligations in the especially difficult context of the rules governing the use of force—an area in which the stakes are unusually high and the incentives to depart from legal constraints can be particularly strong for a militarily...

Edition and Articles

Wed, 17 Jun 2026 00:00:00 +0000

Edition and Articles

New Investigations of Stellate Ganglion Block With ABP-450 (PrabotulinumtoxinA) in Rats

Wed, 17 Jun 2026 00:00:00 +0000

New Investigations of Stellate Ganglion Block With ABP-450 (PrabotulinumtoxinA) in Rats

Maternal immune activation during gestation modulates offspring immune profiles in a nonhuman primate model

Wed, 17 Jun 2026 00:00:00 +0000

BACKGROUND: Maternal Immune Activation (MIA) during pregnancy is an environmental risk factor implicated in neurodevelopmental disorders such as autism spectrum disorder and schizophrenia. While numerous studies have shown that MIA can lead to neuropathological and behavioral abnormalities in offspring, the consequences for immune system development and function are less well characterized. METHODS: To assess the impact of MIA on offspring immune function, we utilized samples from 24 nonhuman primate (NHP) dam-infant pairs. Pregnant dams received either saline (control) or polyinosinic: polycytidylic acid [poly(I:C)] injections in the late first trimester to induce MIA. Dam sickness behaviors and immune response were monitored. Offspring immune status was assessed longitudinally by measuring plasma cytokine, chemokine, and growth factor levels at postnatal days (PND) 30, 90, and 180. Additionally, a complete blood count, including differential leukocyte counts, was performed on...

Can International Law Survive? A Foreword.

Wed, 17 Jun 2026 00:00:00 +0000

Can International Law Survive? A Foreword.

Noise Analysis of Active CMOS Down-Conversion Mixers with LO Waveform and Capacitive-Loading Effects

Wed, 17 Jun 2026 00:00:00 +0000

An analysis of noise mechanisms in active current-commutating down-conversion mixers is presented, which is based on a unified analytical framework that captures the statistical co-dependence of thermal and flicker noise sources across distinct switching transitions, device conduction phases, and varied loading conditions. This study accurately characterizes the memory effect and noise-correlation components induced by capacitive loading, revealing a track-and-hold behavior that differentiates single-balanced and double-balanced topologies beyond conventional common-mode rejection. Furthermore, the impact of local-oscillator (LO) transition times on edge phase noise is rigorously modeled as a dynamic competition between local zero-crossing sensitivity and waveform-dependent noise folding. As will be discussed, notwithstanding its comprehensive scope, the proposed approach yields a closed-form insights into multi-source noise translation, which simplifies to major prior models...

Dysregulated DNA Methylation in Abca4-/- Retinal Pigment Epithelium: Insights into Early Stage of Stargardt Disease

Wed, 17 Jun 2026 00:00:00 +0000

Stargardt disease (STGD1), the most common inherited juvenile macular degeneration, is caused by biallelic mutations in the ABCA4 gene. Currently, there is no approved treatment. In this study, we investigated early-stage epigenomic changes in the retinal pigment epithelium (RPE) of Abca4^-/- mice, a well-established model of STGD1. Reduced representation bisulfite sequencing (RRBS) revealed hypermethylation of gene regions associated with disease-related pathways, implicating methyl-CpG-binding protein 2 (MeCP2) and RE1-silencing transcription factor (REST) as potential regulators. Notably, DNA methylation of a subset of genes preceded their transcriptional change and disease phenotypes in Abca4^-/- RPE. Together with the detected age-dependent increase in MeCP2 levels in Abca4^-/- RPE, these findings suggest that early DNA methylation changes may contribute to RPE dysfunction and eventual cell loss in STGD1.

Human Rights Incorporation Through Impact Assessments at Federal, State, and Local Levels

Wed, 17 Jun 2026 00:00:00 +0000

The United States is obligated to respect and protect human rights by customary international law and international human rights treaties. Currently, no governmental agency is responsible for ensuring these obligations are met, and the government has not yet adopted a comprehensive framework to assess the impact of federal policies and programs on human rights. While various U.S. agencies conduct regular impact assessments in areas including social, economic, and environmental contexts, a similar Human Rights Impact Assessment (HRIA) framework could be valuable. If applied systematically, HRIAs would enable the government to evaluate the human rights implications of current and proposed policies. This article provides an introduction to HRIAs and examples of their use at sub-national, national, and international levels, with the hope that these models will support federal, state, and local government officials in fulfilling their human rights obligations.

Questioning Unaccompanied Immigrant Children: Lessons from Developmental Science on Forensic Interviewing

Wed, 17 Jun 2026 00:00:00 +0000

Questioning Unaccompanied Immigrant Children: Lessons from Developmental Science on Forensic Interviewing

COVID-19 and HPV Vaccine Knowledge Attitudes, and Behaviour among Students at Historically Black Colleges and Universities

Wed, 17 Jun 2026 00:00:00 +0000

Objective: This study examined HPV and COVID-19 vaccination uptake, attitudes, risk perceptions, and exposure to vaccine misinformation among young adults enrolled at historically Black colleges and universities (HBCUs). Methods: Surveys and focus groups were conducted at three southeastern HBCUs. Quantitative data were analyzed using descriptive statistics, and Wilcoxon rank and ANOVA for group comparisons. Qualitative data were examined through content analysis. Results: Most participants identified as religious and female. A majority (86.2%) reported receiving at least one dose of the COVID-19 vaccine, with 56.3% reporting a COVID-19 booster. For HPV vaccination, only 56.3% reported having received at least one dose. Vaccinated students reported higher perceived risk, stronger social support, greater peer motivation, lower endorsement of misinformation, and more positive vaccine attitudes than unvaccinated peers. Unvaccinated participants reported low vaccine confidence and...

A Glass Half Full: Can Local Human Rights Commissions Save International Law in the United States?

Wed, 17 Jun 2026 00:00:00 +0000

A Glass Half Full: Can Local Human Rights Commissions Save International Law in the United States?

Correction: The social amplification and attenuation of COVID-19 risk perception shaping mask wearing behavior: A longitudinal twitter analysis

Wed, 17 Jun 2026 00:00:00 +0000

[This corrects the article DOI: 10.1371/journal.pone.0257428.].

9-1-1 Call Data Modeling to Assess the Influence of a Mass Gathering on Host Community Metrics for Syndromic Surveillance

Tue, 16 Jun 2026 00:00:00 +0000

Introduction: Multi-day planned mass gatherings are prevalent in various forms of sports competitions, concerts, professional, political, and religious conferences. The largest, the World Cup competition, will be hosted by large cities of the United States, Canada, and Mexico in June and July, 2026. These can present risks to the health of spectators, participants, organizers, and host communities, which if discovered faster, facilitates more effective responses in preventing morbidity/mortality. This study demonstrates visually modeled 9-1-1 medical data that uniquely contributes to existing syndromic surveillance activities by its practicality and time sensitivity.

Objectives: Using data from the nine-day period of 2019 Super Bowl LIII festivities, we conducted this retrospective, quantitative, descriptive, population-based study to demonstrate how 9-1-1 emergency medical dispatch (EMD) data could be practically...

Impact of Substance Use Disorder Curriculum and X-Waiver Training on Emergency Medicine Residents

Tue, 16 Jun 2026 00:00:00 +0000

Introduction: We incorporated an 8-hour standardized substance use disorder (SUD) curriculum and X-waiver training into our emergency medicine (EM) residency. We sought to assess whether the implementation of the standardized SUD curriculum and X-waiver training affected graduated EM residents’ comfort with treating SUD and prescribing practices, as well as their view of their future career paths.

Methods: Physicians who completed their EM residency at our hospital from 2016-2022 were invited to complete the survey in 2023. The primary outcome measure was the proportion of surveyed graduates who reported comfort and confidence in treating patients with SUD, measured by affirmative responses to survey items. The secondary outcome measure was the proportion of surveyed graduates reporting that participation in the SUD curriculum and X-waiver training during residency influenced their career plans, measured by affirmative responses...

Single Question vs Ongoing Violence Assessment Tool for Intimate Partner Violence Screening

Tue, 16 Jun 2026 00:00:00 +0000

Introduction: Intimate partner violence (IPV) represents a pervasive and costly public health issue. Many IPV victims seek care in the emergency department (ED) due to injuries or related medical complaints; yet a substantial number of cases remain undetected. The challenge lies in implementing effective screening tools within the demanding environment of an ED. In this study we aimed to assess the efficacy of two brief IPV screening tools— the single question, “Have you been hit, kicked, punched, or otherwise hurt by someone in the past year?” and the 4-item Ongoing Violence Assessment Tool—and to compare them to the more comprehensive Index of Spouse Abuse, a validated 30-item survey that is considered the gold standard for IPV assessment. Our objective was to identify improved strategies for IPV screening in the busy ED setting.

Methods: In this prospective study, every third English-speaking female patient 18-55 years of age presenting...

Making Garbage Great Again: Classification and network-based emissions modeling of California’s waste management and recycling system

Tue, 16 Jun 2026 00:00:00 +0000

Waste management systems are increasingly expected to satisfy environmental, climate, and resource recovery objectives, yet engineering analyses remain constrained by limited empirical characterization of facility operations and infrastructure networks. Although regulatory databases contain extensive information on material flows, they generally do not report the operational activity responsible for energy consumption and emissions, forcing many inventories to rely on representative facilities or generalized emission factors. This dissertation develops an engineering framework for estimating the energy consumption and emissions of California's post-collection waste management system by integrating empirical facility classification, statewide transportation network modeling, and facility activity estimation. The analysis demonstrates that administrative facility categories frequently obscure substantial operational heterogeneity and therefore provide an inadequate basis for...

Understanding the Impacts of New Media on Cinematic Aesthetics

Tue, 16 Jun 2026 00:00:00 +0000

This thesis examines how New Media, especially social media, has influenced contemporary cinematic aesthetics and narrative form in film and television. Through close analysis of three primary case studies—Bo Burnham: Inside, Spider-Man: Into the Spider-Verse, and the ScreenLife film Searching, alongside a discussion of Beast Games and War of the Worlds as negative comparative examples—the project demonstrates the increasing ubiquity of New Media aesthetics in film and television. It first shows how social media’s visual language of authenticity and intimacy has reshaped performance-based media, particularly in comedy specials and reality television. It then analyzes how rapid-cut, highly stylized “retention editing” can be transformed into narratively meaningful hypermediacy. Finally, it considers ScreenLife films and their utilization of a digital mise-en-scène, examining how it can deepen intimacy and characterization, whilst also revealing the limits of the format when...

Patient Monitor Position and Operator Ability to Visualize a Desaturation Event During Intubation

Tue, 16 Jun 2026 00:00:00 +0000

Introduction: During endotracheal intubation, equipment setup typically includes the patient monitor fixed at the head of the bed behind the back of the operator. Inability to directly visualize the patient monitor may result in delayed recognition of desaturation. Our primary aim in this study was to measure the association between patient monitor position and the time to recognition of a desaturation event during endotracheal intubation.

Methods: We performed a randomized crossover trial of emergency medicine residents across two Accreditation Council for Graduate Medical Education-accredited programs. Subjects were asked to perform direct and video-assisted laryngoscopy once on a difficult airway trainer in a simulation. The sequence of laryngoscopy modality (direct vs video-assisted) and monitor position (head vs left vs right of bed) were randomized prior to each attempt. The simulated patient’s peripheral capillary oxygen saturation...

“Everything is Visibly Becoming Judaized, Christianized, Mob-ized”: Israel’s Mastery of the Ascetic Ideal Under a Nietzschean Lens

Tue, 16 Jun 2026 00:00:00 +0000

The moral dissonance of accepting the violation of moral standards in pursuit of religious ends must be accepted as a premise of Israeli geopolitical affairs. However, the devices by which Israel continues to both physically and ideologically expand reveals a logic of domination that extends far beyond the mere realization of religious ideals. Zionism can be read as an attempt to overcome the chronic impotence and diasporic condition Friedrich Nietzsche associates with priestly ressentiment by transforming a historically persecuted people into a sovereign political power. However, the persistence of moral narratives grounded in existential victimhood suggests that state power does not automatically dissolve reactive value-structures. The case of Israel complicates Nietzsche’s master/slave morality dichotomy by demonstrating how modern nationalism can fuse sovereign force with priestly moral legitimation. Using Nietzsche’s Genealogy and some aphorisms from Beyond Good and Evil...

A Systems-based Emergency Department Intervention to Conserve Intravenous Fluids During a National Shortage

Tue, 16 Jun 2026 00:00:00 +0000

Background: Intravenous (IV) fluids are commonly used in emergency departments (ED), but their supply can be vulnerable to national shortages. In September 2024, Tropical Storm Helene disrupted production at a major manufacturing facility, triggering a nationwide IV fluid shortage. In response, our ED implemented a multiphase intervention aimed at reducing non-essential fluid utilization. We aimed to reduce total IV fluid use in the ED by at least 25% through a staged, systems-based conservation strategy.

Methods: We conducted a single-center, retrospective, pre-post quality improvement initiative in a tertiary academic ED with approximately 57,000 annual visits. Interventions were deployed across three Plan–Do–Study–Act cycles: 1) clinician education on fluid stewardship (7 days); 2) protocol modifications to reduce routine IV placement (11 days); and 3) electronic health record (EHR) clinical decision support tools, including...

Erratum to: Search for exclusive Higgs and Z boson decays to ϕγ and ργ with the ATLAS detector

Tue, 16 Jun 2026 00:00:00 +0000

One correction is noted for the paper. The calculation of an angle used to account for meson polarisation in the signal decays was not correct.

The Place of Homoerotic Desire in German Visions of Social Renewal, 1898-1933

Tue, 16 Jun 2026 00:00:00 +0000

This paper evaluates the masculinist segment of the homosexual emancipation movement in early 20th-century Germany in relation to Magnus Hirschfeld's Scientific-Humanitarian Committee, broader German society, and the emerging National Socialist Party. In particular, this paper focuses on how certain masculinists, with varying relationships to the NSDAP, aimed to center homoerotic desire and homosocial bonding within their visions of Hellenistic revival – visions which were otherwise also taken up by the National Socialists. This research primarily examines the images and essays of the early gay publication Der Eigene ("The Self-Owner," or "The Unique One") in this context. Current scholarship on Der Eigene and the masculinists – though limited in comparison to the body of work on the portion of the gay movement associated with Hirschfeld – focuses on the rhetorical dimensions of the attempted reconciliations between masculinist visions of same-sex desire and often-fascist nationalisms....

Search for massive, long-lived particles in events with displaced vertices and displaced muons in pp collisions at s = 13.6 TeV with the ATLAS experiment

Tue, 16 Jun 2026 00:00:00 +0000

A search is presented for massive long-lived particles in events featuring at least one displaced vertex and at least one displaced muon, using proton–proton collision data collected by the ATLAS detector at the Large Hadron Collider from 2022 to 2024 at a centre-of-mass energy of 13.6 TeV. The data sample corresponds to an integrated luminosity of 164 fb − 1 . The analysis targets scenarios in which long-lived particles decay inside the ATLAS inner detector, resulting in a topology of at least one massive, displaced vertex (DV) with multiple associated tracks, and at least one muon with a large transverse impact parameter relative to the primary interaction point. The muon is not required to be associated with the DV. Two signal regions are defined by the transverse distance of the reconstructed DV from the interaction point. Background contributions are estimated by using fully data-driven techniques. No significant excess above the expected background is observed. Upper limits...

No “Golden Hour” in Alaska: Characteristics and Implications of Medevac-centered Emergency Care

Tue, 16 Jun 2026 00:00:00 +0000

Introduction: Rural areas in the United States have higher mortality rates than urban regions, particularly from emergency care-sensitive conditions. Air medical ambulances (medevacs) are critical to emergency care access in the rural U.S., but limited data hinder the ability to study this critical system. In Alaska, medevac services often represent the sole method for connecting Alaska Native patients in remote clinics to physician emergency medical care. This study characterizes medevac use and timing between tribally administered village clinics and hospitals in Northwest Alaska. Our objective in this study was to describe the use and timing of medevacs and investigate how medevac decision-making impacts medevac transport times.

Methods: We conducted a retrospective cohort analysis of medevac transfers between 2020–2024 from 11 Alaskan village clinics within the Maniilaq Association, which serves ~8,000 people over 35,862 square miles.We...

A direct fluorescence assay for quantitative analysis of ornithine decarboxylase activity and inhibitor screening.

Tue, 16 Jun 2026 00:00:00 +0000

Ornithine decarboxylase (ODC) catalyzes the first committed step in polyamine biosynthesis and plays a central role in cellular growth and proliferation. Quantitative analysis of ODC activity has traditionally relied on radiometric or coupled-enzyme assays, which limit scalability and accessibility. Here, we report on the development of 1,2-diacetylbenzene (DAB)-ODC, a fluorescence-based assay that enables direct, sensitive, and high-throughput quantification of ODC activity by detecting putrescine through its reaction with DAB. Using purified recombinant ODC from Saccharomyces cerevisiae and humans, we show that DAB-ODC supports measurement of enzyme activity and accurate determination of steady-state kinetic parameters. Inhibition studies with the inhibitor DL-α-difluoromethylornithine and three recently reported DL-α-difluoromethylornithine analogs yielded IC₅₀ values consistent with those obtained using established orthogonal assays. All enzymatic measurements were...

Subcellular Quantification of Endothelin-1 and HIF-1a in Human Microvascular Endothelial Cells Exposed to Intermittent Hypoxia, Sustained Hypoxia, and Normoxia: Relevance to Obstructive Sleep Apnea

Mon, 15 Jun 2026 00:00:00 +0000

Obstructive sleep apnea is a sleeping disorder characterized by intermittent reductions in blood oxygen levels, known as intermittent hypoxia. Intermittent hypoxia has been linked to upregulation of certain hypoxia induced proteins such as endothelin-1 and hypoxia-inducible factor-1α. These proteins have been linked to a variety of detrimental health effects that are associated with obstructive sleep apnea; however, little is known about their subcellular localization. This study investigates the subcellular localization of endothelin-1 and hypoxiainducible factor-1α in human microvascular endothelial cells. These endothelial cells were seeded onto a coverslip that was exposed to 4 hours of intermittent hypoxia, sustained hypoxia, or normoxia by utilizing a gas-controlled chamber and incubator. Coverslips were fixed we paraformaldehyde, immunostained, and imaged to obtain ten fields of view. Cellpose segmentation software was utilized in each field of view to create binary masks...

Now I am the Master: Transitioning from Learner to Teacher

Mon, 15 Jun 2026 00:00:00 +0000

Now I am the Master: Transitioning from Learner to Teacher

Emergency Department Pediatric Unscheduled Return Visits: Why do patients return and does it matter?

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: Unscheduled return visits are an important quality indicator in the emergency department. We aim to compare clinical characteristics and ED resource usage of pediatric high risk unscheduled return visits (HRURVs) between the index and return visit and explore root cause of HRURVs. Methods: A retrospective chart-review study conducted between November 1, 2014 and October 31, 2015. All patients who returned to the ED within 72 hours of discharge and were admitted or died on re-presentation were considered. Results: The incidence rate of HRURV in our study was 0.96% (95%, CI:0.81-1.13%). We found that significantly more patients were febrile on index visit than on the return visit. In contrast, HRURV patients had significantly more imaging, labs, IV fluids, ED consults and procedures on return visit. Also, the return visit length of stay (LOS) was significantly higher than on index visit (2.76±1.82 Vs. 5.88±0.44). Upon revisit, 2.2% of patients required ICU admission...

Diet-Associated Compounds as Modulators of ?-Synuclein Aggregation

Mon, 15 Jun 2026 00:00:00 +0000

Parkinson’s disease pathology is often associated with the brain, as aggregates of the protein ?-synuclein accumulate in the substantia nigra and lead to neurodegeneration and the characteristic motor symptoms of this disease. However, aggregates of ?-synuclein are also detected in the gastrointestinal tract years before motor symptom onset, supporting the hypothesis that Parkinson’s disease pathology may originate in the gut and propagate to the brain via the vagus nerve. Enteroendocrine cells (specialized epithelial cells) are uniquely positioned at the interface of the gut lumen and the nervous system and are thought to be the source of ?-synuclein in the gut. Previous work in our lab identified a gut bacterial-mediated mechanism of ?-synuclein aggregation in which iron’s interaction with the catechol motif of dopamine plays a central role. Here, we investigate the catechol–iron interaction using a library of diet-associated compounds designed to further elucidate the mechanism...

The Challenge Of Unilateral Leg Swelling In The Emergency Department

Mon, 15 Jun 2026 00:00:00 +0000

Unilateral calf swelling can pose a diagnostic challenge in the Emergency Department. There are several differential diagnoses for this presentation, and the management of one may be a contraindication for another. Point-of-care-ultrasound (POCUS) can be used to identify the aetiology and guide management with confidence. We present a case of an elderly patient with unilateral leg swelling in which DVT was initially suspected. However, POCUS demonstrated a ruptured Baker's cyst with associated calf haematoma. The use of POCUS by emergency physicians can avoid the consequences of unnecessary or harmful treatment and missed diagnosis of venous thromboembolic disease.

Factors Associated with Pediatric Emergency Department Avoidance During COVID-19 Pandemic: A Cross-sectional, Telephone-based Survey in Beirut, Lebanon

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: We aimed to explore avoidant behavior of parents of frequent pediatric Emergency Department (ED) users, reasons behind avoidance and healthcare seeking behaviors in avoiders during COVID-19 pandemic.

Methods: We conducted a cross-sectional telephone-based survey on parents of frequent pediatric ED users at a tertiary care center in Beirut between March and August 2021.

Results: A total of 240 frequent pediatric ED users were included. Female comprised 39.6% of the sample. Of the surveyed patients, 117 reported ED avoidance. ED avoidance was common among parents of patients with concern for their child contracting COVID-19 during an ED visit (aOR=1.28, p<0.001,95%CI[1.13, 1.45]). However, parents of patients with an underlying malignancy/hematologic disease were less likely to refrain from ED visits (aOR=0.29, p<0.001, 95%CI[0.14, 0.60]). Moreover, 97.9% of parents of patients with acute symptoms who avoided the ED reported the fear...

Imposter Syndrome

Mon, 15 Jun 2026 00:00:00 +0000

Imposter Syndrome

To Do, or Not to Do, That Is the Question

Mon, 15 Jun 2026 00:00:00 +0000

To Do, or Not to Do, That Is the Question

Unlocking Structure and Function Relationships of Enzyme@Metal-Organic Frameworks

Mon, 15 Jun 2026 00:00:00 +0000

Enzymes are highly efficient biological catalysts, yet their instability outside native environments limits their practical implementation in industrial and technological applications. As such, immobilization within porous materials has emerged as a promising strategy to enhance enzyme stability, recyclability, and catalytic performance. Specifically, among these materials, metal–organic frameworks (MOFs) provide a uniquely tunable platform due to their controllable porosity, crystallinity, and chemical functionality. Despite growing interest in enzyme@MOF (E@MOF) systems, fundamental structure–function relationships governing enzyme encapsulation, crystallization pathways, and spatial distribution remain poorly understood.This dissertation investigates the formation mechanisms and internal architecture of enzyme-encapsulated MOFs through systematic control of synthetic parameters and the application of advanced cryogenic electron microscopy techniques. First, the role of ligand...

Pitfalls to Avoid while Interpreting Cholinesterase Activity Levels in Cholinesterase Inhibitor Pesticides Poisoning

Mon, 15 Jun 2026 00:00:00 +0000

The cholinesterase activity (AcCh) assay finds an important place in the diagnosis of acute poisoning by cholinesterase inhibitor pesticides, allowing the indication and the efficacy evaluation of antidote treatment with atropine and oximes. AcCh is also a biomarker of effect in occupational exposure to cholinesterase inhibitor pesticides. However, some factors may disrupt AcCh levels and distort the interpretation of the assay results. Hence, the present review aimed to summarize the factors and the variations that may have an impact on the interpretation of AcCh. Indeed, butyrylcholinesterase and acetylcholinesterase are subject to wide physiological individual variations, such as to age, weight and height. Genetic and pathological state may also be factors influencing AcCh levels. The consumption of drugs and daily exposure to some toxicants may also disrupt the AcCh levels, either by direct action on the enzyme or by disrupting its synthesis. In addition, analytical variations...

Refractory Hypoxemia? Is Positive End Expiratory Pressure Always the Answer?

Mon, 15 Jun 2026 00:00:00 +0000

Refractory Hypoxemia? Is Positive End Expiratory Pressure Always the Answer?

MEMC 2023 CONFERENCE ABSTRACTS - PART 1

Mon, 15 Jun 2026 00:00:00 +0000

MEMC 2023 CONFERENCE ABSTRACTS - PART 1

Can PANDAS Swear? A Curious Case of Coprolalia in a 15 Year Old Girl presenting to the Emergency Department

Mon, 15 Jun 2026 00:00:00 +0000

Pediatric autoimmune neuropsychiatric disorders associated with Streptococcal infections, or PANDAS, is a diagnosis of children with an acute and fast onset of obsessions, compulsions or tics succeeding a Group A beta-hemolytic streptococcal infection. Coprolalia is a form of tics where the patient involuntarily says obscene and inappropriate words. We report a case of a 15-year old girl with a history of suspected PANDAS presenting to the emergency department with recurrent coprolalia without signs of a streptococcus infection. PANDAS and other neuropsychiatric syndromes can have different acute presentations. The ED physicians should be familiar with such disorders and presentations.

Juris “Doctor?” Juvenile Substance Use, Recidivism, and Care Efficacy: Evaluating Legal and Medical Approaches to a Public Health Crisis

Mon, 15 Jun 2026 00:00:00 +0000

Substance use among adolescents is both a public health concern and a frequent point of contact within the legal system, yet the institutions that respond to this problem often operate according to different priorities, definitions of success, and pathways into treatment. This dissertation examines how legal and medical systems uniquely address youth substance use through two complementary studies focused on treatment efficacy, harm reduction, and the consequences of institutional influence within systems of care. Study 1 evaluated the Orange County Juvenile Recovery Court (JRC), a specialty treatment court intended to reduce substance use and recidivism among justice-involved youth in Southern California. Using linked retrospective court, arrest, and drug testing data, Study 1 compared JRC graduates, terminal non-completers, and eligible non-enrollees on legal outcomes, substance use trajectories, sobriety, and treatment retention using descriptive analyses, adjusted logistic...

The Emergency Department Boarding Crisis

Mon, 15 Jun 2026 00:00:00 +0000

The Emergency Department Boarding Crisis

Bilateral Post Traumatic Avulsion of Patellar Apexes: A Case Report

Mon, 15 Jun 2026 00:00:00 +0000

Patellar tendon rupture and patellar apex rupture are established complications in patients with end stage kidney disease, however, little to no literature describes bilateral patellar avulsion. This is a case presentation of bilateral knee avulsion due to bilateral patellar tendon rupture at the level of the apexes in a patient with end stage kidney disease on dialysis. A 52 year old female presented to the emergency department for low energy traumatic event. On physical exam patient had bilateral patella alta with limited range of motion. On imaging, bilateral knee MRI was diagnostic of bilateral avulsion of patellar apexes. In light of the clinical and radiological findings, patient was admitted for surgical repair, in which a free tendon graft was placed. Post operation radiography showed good patellar placement and fixation. Upon discharge, patient was allowed partial weight bearing for the first 6 weeks, followed by full weight bearing. 1 year post surgery, patient was pain...

Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest

Mon, 15 Jun 2026 00:00:00 +0000

Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest

We Are At Risk

Mon, 15 Jun 2026 00:00:00 +0000

SURGEON GENERAL’S WARNING

Abortion is Health Care

Mon, 15 Jun 2026 00:00:00 +0000

Why are we making a statement on a political issue? Because this is not one. Bodily autonomy is not a political issue; it is a basic human right that has been turned into a political issue.

A Positive Outcome Post Alteplase, ECMO and Emergent Surgery in a Case of Massive Pulmonary Embolism Cardiac Arrest Complicated by Intra-Abdominal Bleeding

Mon, 15 Jun 2026 00:00:00 +0000

Acute pulmonary embolism is stratified into three groups: low-risk, moderate-risk, and high-risk. Highrisk PE, also known as massive pulmonary embolism (MPE), is defined as an acute PE with sustained hypotension, pulselessness, and persistent bradycardia. Herein, we present a case of a 44-year-old female presenting to the emergency department with shortness of breath, chest discomfort, and central cyanosis. She was found to have MPE and arrested twice during which she received alteplase and Advanced Cardiac Life Support. In the ICU, she arrested for the third time, was resuscitated, and a decision to initiate extracorporeal membrane oxygenation deemed reasonable. The patient deteriorated and was rushed to the operating room after detecting major intra-abdominal bleeding on FAST exam. Hepatic injury was suspected and liver packing was initiated. Patient was safely discharged home neurologically intact after a prolonged hospital stay.

COVID-19 & the Pied Piper Effect on Pediatric Emergency Department Attendances - A Single-Center Study Based in the UAE.

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: The coronavirus 2019 (COVID 19) is an ongoing pandemic that brought significant changes in the healthcare sector, including healthcare-seeking behaviours, population movement, and daily activities. The COVID 19 has significantly affected the influx of paediatric patients attending the emergency department at a tertiary hospital level. This paper aims to measure and study the magnitude and reasons behind the reducing number of children attendances. COVID-19 compares with the disappearing number of children attending PED's to Pied Piper of Hamelin, attracting kids away from their homes as in our old bedtime stories. Methods: Our paper is a single-centre, retrospective, observational study in the Paediatric Emergency Department (PED) and data obtained from Electronic Medical Records and ED Dashboard. We included all paediatric patients who registered in our PED during April, May, and June over three years (2018, 2019, and 2020), including their level of triage and...

Becoming the Senior Resident: Embracing Leadership in Emergency Medicine

Mon, 15 Jun 2026 00:00:00 +0000

Becoming the Senior Resident: Embracing Leadership in Emergency Medicine

The Efficacy of Table Top Simulation as a Didactic Adjunct for an Undergraduate Emergency Medicine Clerkship Curriculum: A Prospective Cross-Over Study

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: Simulation is used by many medical specialties, throughout the world, as an effective educational adjunct to clinical learning experiences. There is limited prospective research to support the use of table-top, low fidelity, simulation experiences as a suitable replacement for traditional lecture-based modalities in the context of undergraduate emergency medical education. We designed, implemented and evaluated sections of a table-top simulation-based curriculum for fourth year medical students participating in the department’s advanced emergency medicine clerkship. Methods: A prospective, randomized, cross over study comparing lecture-based learning activities to an experimental table-top simulation exercises based on a primary outcome objective, considering the quantitative acquisition of clinical knowledge, and a secondary outcome looking at the results of survey data, considering student perspectives on learning experience. Four student cohorts participated in...

Captivating Capnography – The Basics of End-Tidal CO₂

Mon, 15 Jun 2026 00:00:00 +0000

Capnography is most known for its use in confirming endotracheal tube placement and assessing the effectiveness of CPR. However, there are several other clinical scenarios where end tidal CO₂ (ET-CO₂) can provide us useful information.

Why I No Longer Teach ATLS

Mon, 15 Jun 2026 00:00:00 +0000

Why I No Longer Teach ATLS

MEMC 2025 CONFERENCE ABSTRACTS

Mon, 15 Jun 2026 00:00:00 +0000

Abstracts Presented at the XIIIth Mediterranean Emergency Medicine Congress - MEMC25 at Semmelweis University,

Budhapest, Hungary

August 14-17, 2025

High Level Disinfection at Bedside? High Level Disinfection Wipes for Ultrasound Probes in the ED

Mon, 15 Jun 2026 00:00:00 +0000

A 26-year-old woman presents with a oneday history of lower abdominal cramping. She reports a positive home pregnancy test, with her last menstrual period occurring six weeks ago. On examination, she is hemodynamically stable but has mild tenderness in the suprapubic region. You perform a bedside transvaginal ultrasound confirming a 6-week intrauterine pregnancy with an appropriate fetal heart rate and no adnexal masses. After reassuring her, you arrange follow-up with the on-call OB/GYN and discharge her within 90 minutes of her arrival. As you hand the transvaginal ultrasound probe to the ED technician, they ask for guidance on how to properly clean it.

Typically, probes used on the skin surface are cleaned after each use by removing visible contamination, followed by disinfection with a lowlevel disinfectant (LLD). LLDs, which are often alcohol- or quaternary ammonium compoundbased, are applied via spray or wipes.

However, internal probes, such...

What is ED Operations?

Mon, 15 Jun 2026 00:00:00 +0000

What is ED Operations?

Development and Evaluation of ADOPT-Based Microfluidic Workflows for Live Suspension Single Cell Imaging

Mon, 15 Jun 2026 00:00:00 +0000

Live suspension cells are difficult to image because they are not naturally immobilized and may drift during acquisition. A novel Arrayed-Droplet Optical Projection Tomography (ADOPT) platform could potentially address this challenge by encapsulating cells in droplets and using oil-flow-induced microvortices to rotate the cells for multi-angle imaging. This thesis evaluated an ADOPT-based imaging platform using the ZOT Trap as the primary cell trapping and imaging microfluidic device. For the conventional workflow, pressure-controlled droplets were generated and loaded into the ZOT Trap. Then, they were exposed to oil perfusion to induce cell rotation. Selected single cell droplets were then imaged using brightfield and fluorescence microscopy. K562 cells and CD28-activated CD8+ T cells were imaged with this workflow. This thesis also explored a preliminary One-step Imaging approach as a simplified modification of the ADOPT system. This approach attempted to bypass the droplet...

Foundations for Computable Bayesian Epistemology

Mon, 15 Jun 2026 00:00:00 +0000

Bayesianism aims to provide a unified normative theory of belief and rational decision. However, there has been a concern among Bayesians that the theory makes implausibly strong assumptions about agents’ cognitive power. How can Bayesianism be normative for agents like us, if we have no hope of satisfying its basic assumptions? This dissertation provides a mathematical and philosophical foundation for the emerging field of computable Bayesianism. The field aims to reformulate classical Bayesianism via techniques from computable analysis. I first show that the field is philosophically productive, shedding new light on classical Bayesian problems; I then provide foundational theorems that ground its most basic concepts—computable probability, computable utility, and algorithmic randomness—in the philosophical framework of subjective Bayesianism.

Turning Foes to Friends: Establishing Collegiality in the ED

Mon, 15 Jun 2026 00:00:00 +0000

Turning Foes to Friends: Establishing Collegiality in the ED

Solutions for the “Vanishing Drug” Conundrum in Lebanon: A Change in the Subsidy System Coupled with a Digital Prescribing Platform

Mon, 15 Jun 2026 00:00:00 +0000

The shortage of foreign currency in Lebanon due to the multiple crises that the country has been facing since October 2019 poses a threat to the importation and availability of pharmaceutical products among other essential commodities. This has been remedied by an importation subsidy system for pharmaceuticals financed by the central bank’s foreign reserves. However, patients have recently experienced shortages of many drugs on pharmacy shelves. In this paper, we describe the pharmaceutical supply chain in Lebanon along with the subsidy system put in place by the central bank. We then propose recommendations to improve this subsidy system and enhance prescribing practices in order to ensure the continuous presence of medications on pharmacy shelves, and that the foreign currency supplied by the central bank is spent to the benefit of the Lebanese patient.

Characterization and clinical management of adverse events following treatment with repotrectinib: a TRIDENT-1 analysis.

Mon, 15 Jun 2026 00:00:00 +0000

Background

Repotrectinib, a next-generation ROS1/TRK tyrosine kinase inhibitor, is approved for ROS1 fusion-positive non-small cell lung cancer and NTRK fusion-positive solid tumors. Its side effects and safety management strategies require further characterization.

Patients and methods

The safety profile of repotrectinib (treatment-emergent/related adverse events [TEAEs/TRAEs]) was established in patients who initiated treatment at the recommended dose (160 mg daily [QD] for 14 days, then 160 mg twice daily [BID]) across all cohorts of the global, multicenter phase 1/2 TRIDENT-1 study. AE management strategies were outlined.

Results

In 472 patients, the most common TRAEs (dizziness [58%] and dysgeusia [50%]) were likely TRK inhibition-related. Median relative dose intensity was 90%; 14% (n = 66/472) of patients did not increase their initial QD dose to BID (mostly due to CNS AEs). Rates of dizziness (median onset, 7 days) were similar in patients with/without...

Assessment of Automated External Defibrillators and Cardiopulmonary Resuscitation Training in Lebanese Schools

Mon, 15 Jun 2026 00:00:00 +0000

Introduction: Sudden cardiac arrest accounts for 5% to 10% of deaths among children. Survival following out-of-hospital cardiac arrest depends on quick recognition, early cardiopulmonary resuscitation (CPR) and defibrillation. In Lebanon, the survival rate of children following such arrests is low (16.7%). Consequently, this study assesses availability of automated external defibrillators (AED) and CPR/AED training in Lebanese schools. Methods: This is a cross-sectional phone-based survey study conducted using a randomized sample of 175 private, private-free and public schools - representative of all of the country regions. Results: Among surveyed schools, 99 responded with a complete participation (56.6% response rate). Most surveyed schools were public. 28% had at least one individual who underwent CPR or/and AED training, and only 2 schools had an AED. 4 schools reported a history of SCA, 3 of them were confirmed dead, and those 4 schools did not have an AED. The main...

How to Stand Up for Science and Fight Burnout

Mon, 15 Jun 2026 00:00:00 +0000

How to Stand Up for Science and Fight Burnout

Understanding the Impacts of Telecommuting on Travel Behavior Before, During, and After the Pandemic

Mon, 15 Jun 2026 00:00:00 +0000

The COVID-19 pandemic catalyzed a massive and abrupt shift in work arrangements across the United States, with telecommuting (or working from home) becoming a dominant mode for a substantial portion of the workforce. This shift not only disrupted traditional employment structures but also significantly altered daily activity schedules and travel behavior. As policymakers and planners seek strategies to manage travel demand, mitigate congestion, and reduce greenhouse gas emissions, understanding the long-term implications of telecommuting on travel patterns is essential. The pandemic offers a unique opportunity to study these changes at scale and across diverse geographic and demographic groups.

Adding Insult to Injury: Resident Mistreatment in Emergency Medicine

Mon, 15 Jun 2026 00:00:00 +0000

Adding Insult to Injury: Resident Mistreatment in Emergency Medicine

IMGs are still MDs

Mon, 15 Jun 2026 00:00:00 +0000

What is an IMG you ask? IMG stands for International Medical Graduate. This includes anyone who attended and obtained their medical degree from outside the United States. Even though they may be a U.S. citizen and went to school outside the United States, they are still categorized as an IMG. However, you will have U.S. preceding the IMG, thus resulting in the title of US IMG versus non-US IMG (IMG that is not a U.S. citizen). But, in all seriousness, labelling an MD as an IMG not still an MD?

Brown Recluse Spider in the Mediterranean Region: A Review of the Literature

Mon, 15 Jun 2026 00:00:00 +0000

Spiders are eight-legged arthropods that belong tothe arachnids class and are found on every continentexcept Antarctica.1 As of 2020, there are over 48000recognized species of spiders with more than 5000in the Mediterranean area. Out of these, only twospiders, the Latrodectus tredecimguttatus and theLoxosceles rufescens are of medical significance in theMediterranean area.1 Although most spider bites arebenign; however, severe reactions and life-threateningenvenomation do occur.

Achenbach Syndrome: Minor Traumatic Injury as a Possible Etiology

Mon, 15 Jun 2026 00:00:00 +0000

Achenbach syndrome is a rare cause of acute bluish discoloration and swelling of one or more digits, of unknown etiology. The condition is self-limited and benign but is worrisome for both patients and healthcare providers due to its emulation of peripheral ischemia. Familiarity with the clinical features of Achenbach syndrome allows for rapid diagnosis and mitigation of costs and anxiety associated with unnecessary testing and referrals. We report a case of Achenbach syndrome associated with a puncture wound, which supports a traumatic etiology for this condition.

Beirut Port Blast 2020: New Lessons Learned in Mass Casualty Incident Management in the Emergency Department

Mon, 15 Jun 2026 00:00:00 +0000

Background: On August 4, 2020, Lebanon suffered its largest mass casualty incident (MCI) to date: the Beirut Port blast. Hospital emergency response to MCIs is particularly challenging in low- and middleincome countries, where emergency medical services are not well developed and where hospitals have to rapidly scale up capacity to receive large influxes of casualties. This article describes the American University of Beirut Medical Center (AUBMC) response to the Beirut Port blast and outlines the lessons learned.

Discussion: The Beirut Port blast reinforced the importance of proper preparedness and flexibility in managing an MCI. Effective elements of AUBMC's MCI plan included geographic-based activation criteria, along with use of Wi-Fi messaging systems for timely notification of disaster teams. Crowd control through planned facility closures allowed medical teams to focus on patient care. Pre-identified surge areas with prepared disaster cart deployment allowed...

Lessons Learned from the COVID-19 Pandemic: Physician Safety and Coverage in Lebanon

Mon, 15 Jun 2026 00:00:00 +0000

Similar to other countries, Lebanon experienced the challenges that the COVID-19 pandemic imposed on its healthcare system. Physicians, among other healthcare workers, felt the large toll of the pandemic. The growing number of physicians infected with the coronavirus has uncovered gaps in the policies and laws meant to protect and ensure physician safety. These include gaps in physician coverage for healthcare, disability, and death, in addition to particular vulnerabilities of trainee physicians, along with the absence of specific laws, strategies, and agencies to ensure the safety of the healthcare work environment. This paper highlights these gaps and proposes solutions to address them.

Oxygen is for the Weak

Mon, 15 Jun 2026 00:00:00 +0000

Oxygen is for the Weak

Are Emergency Physicians’ Brains Different?

Mon, 15 Jun 2026 00:00:00 +0000

Emergency physicians are used to not knowing all of the facts. Our professional brain is trained to gather all of the immediately available data which can reasonably be obtained within the time constraints of the emergency department and then decide and act. This timeframe can be seconds or minutes but not usually more than a couple of hours. We do not have the luxury of expansive history gathering, data collection, discussion, and reflection. Every emergency physician has had to come to terms with the stressful reality of having to decide something really important without enough information. We make the decision to admit or discharge and then have to move on to the next patient. Just think for a second about how long you really deliberate on whether or not to admit the 45-year-old guy with chest pain with the normal EKG. You do not have the luxury of time in making decisions and this is the dilemma of the decision-making process which separates different types of physicians. ...