Buffalo State University

Recent advancements in brain research have drastically increased the need for serious ethical consideration. Postmortem brain research has taken a significant step in the development of BrainEx. The technology can metabolically resuscitate pig brains from pigs that were “clinically dead” for hours. Ethical discourse around organoids ranges from being overly cautious and sensational to highly permissive and skeptical of even minimal consciousness emerging in such a model. Some of these criticisms are allayed in postmortem brains. As such, postmortem brain research presents philosophers and policymakers with a higher risk model of being conscious. The outcome of researchers unknowingly subjecting postmortem brains to negative mental states through research will be termed brain-in-a-vat-world. We will provide some motivation to believe this is a reasonable outcome of proceeding with postmortem brain research. As such, we propose applying the PP to all postmortem brain research. These precautions go beyond previous precautions of brain activity monitoring and the willingness to administer anesthetics to the brains should they appear awake. These precautions aim to avoid potential negative mental states. Such precautions reasonably mitigate the risk of postmortem brain research causing suffering. We recommend several practical precautions. First, anesthetics may prevent any conscious experience at all, cingulotomies prevent painful experiences, and the administration of opioids may prevent boredom or isolation. IRBs should work to determine how these precautions interact with experimental outcomes and how to balance the risk of side effects in light of the experimentation period. The upshot of the article is such PP applications avoid overapplication of the PP, which has occurred in the brain organoid literature. Further, the PP, we argue, provides better guidance to precautionary policy than decision theory, given the difficulties with applying decision theory in medical ethics.

Background Hypofractionated stereotactic radiosurgery is an effective technique to treat larger brain metastases and post-surgical cavities. Adaptive Gamma Knife radiosurgery (aGKRS), involving repeat magnetic resonance imaging (MRI) and replanning based on modified lesion contours, has emerged as a solution to account for inter-fraction tumor dynamics. Objective To evaluate the impact of adaptive planning on treatment metrics, radiation dose to structures at risk (SARs), and clinical and radiologic outcomes in patients with brain metastases. Methods Over an 8-year period (2016–2023), 31 patients were treated with aGKRS to 48 brain metastases. Lesions were re-contoured and adaptive plans created using updated MRIs acquired prior to the second radiation fraction. Treatment metrics, including target coverage, Paddick Conformity Index (PCI), Gradient Index (GI), and doses to SARs, were analyzed. Clinical outcomes and radiologic response were assessed. Results Lesion volumes changed significantly between radiation fractions (mean change– 28.25%). aGKRS resulted in significant improvements in target coverage, from 91.9% on non-adaptive plans to 97.02% following adaptive replanning. The PCI improved by 35.3% across plans in this series. Adaptive plans also reduced the dose to SARs by an average of 4.7%. Radiologic response was excellent– median volume reduction of treated lesions was 98.9%. Clinically, 72% of patients either remained stable or improved in neurologic status; 32% improved in performance status by at least one grade. Conclusion Lesion dynamics during hypofractionated treatments pose a significant challenge to the delivery of conformal and safe SRS treatments. aGKRS significantly improves dosimetric parameters, reduces radiation to SARs, and enhances clinical and radiologic outcomes for brain metastases.

In this article, the writer presents a review of the 11th edition of Nursing Today: Transitions and Trends , edited by JoAnn Zerwekh and Ashley Zerwekh Garneau (2023). This book consists of 26 chapters divided into five units exploring professional nursing’s growth and transitions, the development of the profession, nursing management, current issues in healthcare, and contemporary nursing practice. This book is pertinent to the knowledge base of undergraduate level nursing students in the final semesters of their nursing program.

Weight‐based victimization represents a critical challenge for youth, particularly those with obesity, and has been linked to a range of negative psychological, academic, and behavioral outcomes. While research has extensively examined in‐person victimization, the rise of digital platforms has given way to weight‐based cybervictimization, which remains understudied. This paper highlights the urgent need for research, prevention, and intervention strategies focused on weight‐based cybervictimization, emphasizing its harmful effects and its overlap with traditional forms of victimization. It identifies gaps in the existing literature, particularly regarding the inconsistent use of assessment tools and terminology in research on weight‐based victimization, and proposes the necessity for culturally relevant and validated measurement tools that accurately capture youth experiences. Finally, it aims to inform best practices for healthcare providers, educators, and parents by promoting strategies that effectively address and mitigate the impact of weight‐based victimization among youth.

People in the criminal justice system, especially those enrolled in drug treatment courts, have complex health profiles, limited access to medical and dental care, and a high prevalence of substance use disorders (SUD). SUD is associated with poor oral health, including severe dental caries and periodontal disease. Both poor oral health and SUD can contribute to low self-esteem and stigma that pose barriers to seeking care. The aim of this study is to examine dental care and oral health disparities among community-dwelling justice-involved people with SUD enrolled in the drug treatment courts. We surveyed clients (N = 59) and leadership team members (n = 23) in four drug treatment courts. Clients responded to questions about dental care needs and self-reported oral health; leadership team members provided their perspectives on clients’ oral health needs and barriers to care. Most clients (61%) rated their oral health as fair to very poor, and 27% had not seen a dentist in at least 3 years. Most (70%) leadership team members indicated that clients had occasionally or frequently discussed an oral health problem and 26% noted that clients occasionally or frequently missed court due to dental pain. Both clients and team members identified cost, transportation, fear, and stigma as key barriers to addressing clients’ dental health needs. Improving oral health for justice-involved people with SUD may entail a multifaceted approach to address these barriers, and might consider novel approaches, such as co-locating dental and SUD providers.

Study Design Retrospective case series. Objective The objective of this study is to report on the demographics, symptoms, and treatment course of a series of adult trauma patients who presented with jumped facets. Summary of Background Data Jumped facets are rare traumatic cervical spine injuries that result in significant instability. These can be unilateral or bilateral, and they are often associated with serious spinal cord injuries. Methods All patients over 18 years old who presented at a single level 1 trauma center between September 2015 to March 2023 with a cervical spine injury were identified. Patients were included if they had jumped facets diagnosed on computed tomography (CT) scans. Patients were excluded if they were under 18 years old and/or did not have a diagnosis of jumped facets. Demographics, cervical spine characteristics, American Spinal Injury Association (ASIA) impairment scale scores, treatment course, and intrahospital data for all patients were collected. Results Of the 554 patients identified, 11 patients met the final inclusion and exclusion criteria. The average age of the participants was 50.6 ± 22.1 years; 72.7% were male. The most common mechanism of injury, 9 (81.8%) patients, was a motor vehicle crash (MVC). All injury levels fell between levels C4 and C7. Six (54.5%) patients had motor and sensory deficits. Two (18.2%) patients had an ASIA score of A. All patients underwent surgical treatment, and 7 (63.6%) patients were treated with both an anterior and posterior approach. Patients spent a median of 12.0 (IQR: 10.0) days in the hospital. Conclusions In this series of patients, the majority of patients who sustained jumped facets were middle-aged men who were involved in an MVC. While most patients did not have complete spinal cord injuries, all patients underwent urgent reduction and stabilization. Therefore, in an attempt to best help patients regain as much function as possible, we recommend prompt reduction and stabilization. Level of Evidence Level IV.

Background Performing a craniotomy for chronic subdural hematoma (cSDH) in elderly patients with comorbidities can be challenging. The Subdural Evacuating Port System (SEPS; Medtronic, Dublin, Ireland) offers a less-invasive alternative, while middle meningeal artery embolization (MMAE) has shown effectiveness in preventing cSDH recurrence. However, the combined effectiveness of SEPS and MMAE (SEPS + MMAE) remains unclear. This study reports the outcomes of patients undergoing a combination of these procedures for the treatment of cSDH. Methods A retrospective review of our medical records database was conducted to identify patients with cSDH who were treated with SEPS + MMAE between January 1, 2021, and April 1, 2024. Demographics, comorbidities, procedure, and outcomes data were analyzed. cSDH resolution was tracked by measuring hematoma volumes on noncontrast computed tomography scans pre-SEPS + MMAE, 24–48 h postprocedure, and 6–8 weeks postprocedure. Results A total of 35 patients (median age: 77 years [interquartile range (IQR):69–85.5]; men:woman = 22:13) with 49 cSDH, of which 41 cSDHs receiving combined SEPS + MMAE were included. Notably, 38 (92.7%) of the 41 cSDHs were holohemispheric, and 15 (36.6%) had an acute or subacute component. The median pre-SEPS + MMAE cSDH volume was 121.9 mL [IQR:87.9–153.4 mL] with a median midline shift of 6.6 mm [IQR:3.5–10 mm]. All MMAE procedures were performed under conscious sedation. The femoral approach was utilized in 19 patients (54.3%). Three patients required rescue craniotomy. Median post-SPES + MMAE volume was 71.1 mL [IQR:54.5–93.2], resulting in a 38% [IQR:21.9–53] reduction in cSDH volume; and median follow-up SEPS + MMAE volume was 22 mL [IQR:2–59.2] resulting in an 81% [IQR:50.9–98.1] reduction in cSDH volume, compared to pre-SEPS + MMAE levels. Seven (17.1%) patients required readmission for residual or recurrent cSDH within 90 days. Five of these patients were retreated (12.2%), two of whom required craniotomy (4.9%). Conclusion Our experience suggests that SEPS + MMAE was an effective method of cSDH treatment and was associated with low complication rates.

Flexible intramedullary nail fixation of pediatric femoral shaft fractures offers advantages such as shorter hospital stays, faster return to function, and less associated costs when compared with traction and casting. This study compared the biomechanical performance of three configurations: 2CS, 2CL, and 3CL. Thirty synthetic femur models with identical, length-unstable, spiral fractures were tested using a three-dimensional camera system to assess real-time micromotion. Three groups were analyzed: (a) 2CS – two 3.5 mm C- and S-shaped nails inserted anterograde, (b) 2CL – one ‘C’ and one ‘S’ shaped 3.5 mm titanium nail-inserted retrograde from a single lateral entry, (c) 3CL – two ‘C’ shaped 3.5 mm titanium nails inserted medially and laterally with a third ‘C’ shaped 2.5 mm nail placed retrograde from an anterolateral site. Torsional loading, cyclical loading, and load-to-failure tests were conducted. The 3CL configuration demonstrated superior biomechanical performance. It exhibited the highest torsional stiffness [0.67 ± 0.06 Nm/° for external rotation (ER), 0.404 = ± 0.06 Nm/° for internal rotation (IR); P = 0.002], least displacement (0.05 ± 0.02 vs. 0.30 ± 0.02 mm for 2CL and 0.57 ± 0.05 mm for 2CS; P = 0.012), and required the highest load-to-failure (162 ± 83 vs. 106 4 ± 75 N for 2CL and 790 ± 34 N for 2CS; P = 0.016).The 3CL configuration provided superior strength and stability across all tests, supporting its role in the fixation of length-unstable pediatric femoral fractures.

Questions of data privacy in Africa are imbued with complexity. We examine a slice of this complexity by putting the concept of contextual integrity into dialogue with Africa's plural-legal contexts to explore data privacy within Africa's emerging digital landscape. The conceptual insights are empirically illustrated based on a case study in Ghana, involving content analysis of policy documents and interviews with a sample of residents, cultural leaders (among the Akan ethnic group), subject matter experts, and digital entrepreneurs (e.g. fintech firms). Our findings illuminate a nuanced and contextually rooted understanding of privacy, focusing on the complementarities and tensions around data anonymization for privacy; the multiplicity of information spheres that result in a complicated terrain of privacy breaches; and the individuality, mutuality, and collectivity of privacy harms and remedies thereof. Our findings challenge prevailing discourses in the literature that either suggests (a) misalignments between locally-rooted privacy norms and European-imported statutory regulations on privacy in African countries or (b) privacy myopia among Africans—underestimating their personal information and the need to protect such information. We suggest shifting away from such privacy discourses from above (meta-narratives, generalizations, and inherent assumptions on African states and societies) to conversations from below. That is, refocusing on the particularities of place, culture, and norms that complicate meta-narratives on privacy. This requires centering the everyday privacy norms that result from co-existing, and sometimes oppositional, customary-informed and state-stipulated information norms within Africa's emerging digital landscapes.

The abundance of medical misinformation and disinformation on the internet, particularly through social media, is a public health concern. Vaccine hesitancy exemplifies how myths and misperceptions driven by mis- and disinformation affect patient care and population health. Conversations about vaccine hesitancy are challenging but necessary, and an interprofessional, team approach can be effective and efficient. A successful outcome requires health workers to have a good working knowledge of vaccines and strong interpersonal skills. Interprofessional education (IPE) provides an opportunity to teach students the value of interprofessional collaborative practice (IPCP), the implications mis- and disinformation have on patient care and public health, and how to approach conversations about vaccine hesitancy. Interprofessional instructional design strategies that can be used to equip health occupations students with the knowledge and skills they need include simulation-based learning, team-based learning, and gamification, with virtual and augmented reality on the horizon. While IPE is challenging, a thoughtfully designed educational program can prepare health occupations students for IPCP. This chapter intends to inform health professions educators on how to design and implement interprofessional learning experiences that equip future health workers with the knowledge and skills they need to address vaccine misinformation and disinformation.

Coastal regions in North America face significant threats from storm surges caused by hurricanes and nor’easters. While traditional numerical models offer high-fidelity simulations, their computational costs limit their use for real-time predictions and risk assessments. Recently, deep learning has been developed for efficient storm surge prediction using storm parameters as inputs. However, resolving small scales of storm surge in both time and space over long durations and large areas often requires large neural networks prone to accumulating prediction errors over time. This study introduces the hierarchical deep neural network (HDNN) technique integrated with a convolutional autoencoder to accurately and efficiently predict storm surge time series. The autoencoder reduces the dimensionality of the storm surge data, streamlining the learning process. The HDNNs then map storm parameters to the low-dimensional representation of storm surge, enabling sequential predictions across different time scales. Specifically, the current-level neural network predicts future states with larger time steps, which are passed as inputs to the next-level neural network for smaller time-step predictions. This process continues sequentially for all time steps. The simulation results from different-level neural networks across various time steps are then stacked to acquire the entire time series of storm surge. The simulated low-dimensional representations are finally decoded back into storm surge time series. The model was trained and evaluated using synthetic data from the North Atlantic Comprehensive Coastal Study (covering critical coastal regions within New York and New Jersey), achieving excellent performance on the test scenarios (root mean square error = 0.055 m, mean absolute error = 0.027 m, and coefficient of determination = 0.966), respectively. The obtained results demonstrate its ability to effectively handle high-dimensional surge data while mitigating error accumulation, making it a promising tool for advancing spatio-temporal storm surge prediction.

For decades, precarious manhood theory has suggested that men are expected to prove their masculinity, given that it is a hard-won, tenuous state requiring continual social proof and constant validation. However, there is an emergent body of research that challenges these tenets and indicates that some men do not adhere to gendered expectations of their biological sex at work—which we refer to as counter-normativity. We conducted a systematic review to organize and synthesize this literature, thereby extending precarious manhood theory. Our review suggests the hegemonically masculine roots of precarious manhood theory are not uniformly idealized or revered as previously theorized, because counter-normative men do not necessarily value enacting the associated norms. In addition, women are often the punitive party, which is of note given that men’s counter-normativity is typically described as their acting like a woman, and is purportedly one of the worst things a man can do. Finally, although counter-normative men are largely punished in their organizations for breaking gender stereotypes, there are instances where they experience positive or neutral outcomes. We conclude by guiding forthcoming scholarship on masculinity at work, suggesting important implications for managing gender complexities in today’s work settings.

Ice-sheet volume during Marine Isotope Stage (MIS) 3 (57–29 ka) is controversial. Several recent studies have proposed that the Greenland Ice Sheet was smaller during MIS 3 than it is today based on radiocarbon ages of molluscan bivalve shells reworked into sedimentary deposits adjacent to the present ice margin. Such a result contrasts with available records of MIS 3 climate, ice volume, and sea level. We revisited a site previously interpreted as containing evidence for smaller than present ice during MIS 3. We collected marine bivalve shells and combined progressive acid dissolution in preparation for radiocarbon dating with new-generation amino acid analysis, which focuses on aspartic acid racemization. Our results suggest that contamination by young carbon yields finite radiocarbon ages despite bivalve shells likely dating to MIS 5e (∼125 ka) or even older. This result should be further tested, which could be accomplished with additional studies of this kind in combination with ice-sheet modeling and additional paleoclimate data generated from adjacent seas.

Objetivo: La evasión de la información de salud es un obstáculo crítico para llegar a las personas con mensajes de salud y, en última instancia, disminuye la adopción de medidas preventivas vitales por parte de la población, como la detección oportuna del cáncer colorrectal (CRC, por sus siglas en inglés). Realizamos un experimento doble ciego, preinscrito, para evaluar la eficacia de intervenciones breves con vídeos narrativos diseñados para promover la detección oportuna del CRC, mitigando una de dos causas conocidas de la evasión de la información de salud: baja autoeficacia y baja percepción de control sobre los resultados de salud. Métodos: Participantes (N = 776, de 45 a 75 años, sin adherencia al cribado, o la detección oportuna, de CRC, sin antecedentes de CRC) reclutados de “Prolific,” un grupo de participantes en línea, fueron asignados aleatoriamente a ver un vídeo de intervención (colonoscopia que promueve el control percibido, colonoscopia que promueve la autoeficacia, “FIT” que promueve la autoeficacia) o un vídeo de control (vídeo de control de la atención sobre seguridad alimentaria, vídeo informativo sobre CRC). Posteriormente, los participantes completaron evaluaciones de búsqueda de información sobre CRC, intenciones de cribado y actitudes hacia el cribado. Resultados: En comparación con un video de control atencional, los tres videos de intervención mejoraron los cuatro resultados; fueron efectivos tanto para personas con alto nivel de evitación de información sobre el CRC como para quienes no lo presentaban. Los efectos de los videos de autoeficacia se mediaron a través de una mayor autoeficacia. Los efectos de los videos de control percibidos no se mediaron a través de un mayor locus de control de salud. Las interacciones entre la condición del video y la evitación no fueron significativas. Los videos de intervención no fueron más efectivos que el video informativo sobre el CRC. Conclusiones: Solo el 58% de la población adulta estadounidense cumple con las pruebas de detección del CRC, y la tasa es menor entre quienes evitan la información sobre el CRC. Al aumentar la búsqueda de información sobre el CRC, las actitudes positivas y la intención de realizar las pruebas de detección, estos videos disponibles públicamente podrían tener un impacto generalizado en la salud pública.

Study Design Clinical case series. Objective The objective of this case series is to describe the demographics, mechanisms of injury, radiologic imaging measurements, and treatment of unilateral cervical facet fractures in adult trauma patients. Summary of Background Data Unilateral cervical facet fractures are rare and traumatic injuries of the spine that are frequently misdiagnosed and misclassified. There is a lack of consensus on the appropriate management for various severities of unilateral facet fractures. Methods All patients over 18 years old who presented at a single center between September 2015 and March 2023 with a unilateral cervical facet fracture were identified. Fracture height and percentage of the lateral mass were measured on computerized tomography (CT). Demographics, treatment course, and intrahospital data were collected. Results Of the 554 patients identified, 22 met final inclusion and exclusion criteria. The median age was 37.5 (IQR: 36) years, and 68% were male. The most common mechanisms of injury were a motor vehicle crash (55%) or a fall (23%). Seven (32%) patients required surgical intervention, and 15 (68%) patients were treated nonoperatively. The average fracture height for all participants was 1.11 ± 0.4 cm, and the average percentage of the lateral mass was 42.3% ± 18.0%. After 1 year of follow-up, all patients treated nonoperatively had successful outcomes, with no treatment failures or need for surgical intervention. Conclusion Patients who sustained a unilateral cervical spine facet fracture from a traumatic injury mechanism with fracture fragments >1 cm or >40% of the lateral mass on CT scan can effectively be treated nonoperatively. No patient treated nonoperatively failed treatment and required surgery at 1 year. We recommend considering operative intervention in patients with high-energy mechanisms of injury coupled with the abovementioned radiographic parameters.

In this work, we describe the easy synthesis of mercury complexes with the 1,5,9‐trimesityldipyrromethene (MesDPM) ligand. The compounds were characterized using standard analytic methods such as NMR, IR, as well as UV/Vis spectroscopy. The molecular structures in solid state were determined by SC‐XRD experiments. In addition, the 199Hg NMR chemical shifts were determined by measurements and quantum chemical calculations.

Delays in biological systems are a common phenomenon. The models for delays require specialized mathematical and numerical techniques such as transit compartments, delay differential equations (DDEs), and distributed DDEs (DDDEs). Because of mathematical complexity, DDEs and particularly DDDEs are infrequently used for modeling. DDEs are supported by most pharmacometric programs. Recently, DDDEs have been implemented in NONMEM that greatly improve the applicability of this technique in pharmacokinetic and pharmacodynamic (PKPD) modeling. The objective of this tutorial is to provide examples of PKPD models with delays and demonstrate how to implement them in NONMEM. All examples provide a brief description of the biology and pharmacology underlying model equations, explain how they are coded in the NONMEM control stream, and discuss results of data analysis models were used for. NONMEM codes for all models are presented in supporting information (Data S1). The tutorial concludes with a discussion of the pros and cons of presented delay modeling techniques with guidelines for which one might be preferred given the nature of the delay, available data, and the task to be performed.