University of Hawaii System

Background Wrestling is among the most common youth sports in the United States, with about 260,000 high school participants annually. There is a lack of literature investigating wrestling injury profiles and mechanisms of injuries. In the past 15 years, urgent care utilization has increased, and National Federation of State High School Associations (NFHS) concussion protocols have been developed and implemented. Purpose/Hypothesis The purpose of this study was to analyze causes, diagnoses, body parts, and trends associated with wrestling injuries presenting to US emergency departments. It was hypothesized that there would be (1) decreased overall injuries presenting to emergency departments because of increased urgent care utilization and (2) decreased concussions because of the NFHS rule implementation and revision. Study Design Descriptive epidemiology study; Level of evidence, 3. Methods Youth wrestling injuries presenting to US emergency departments between January 1, 2013, and December 31, 2022, were queried from the National Electronic Injury Surveillance System database. The data included date of presentation, age, sex, race, body part, injury diagnosis, disposition, and a brief injury narrative. National estimates (NE) were calculated using the associated statistical weight of the reporting hospital. Linear regressions were performed to investigate the relationship between year and NE for overall injuries, diagnoses, body parts, mechanisms of injury, and other subanalyses. Statistical significance was set at P < .05. Results A total of 8628 (NE = 296,502) wrestling injuries met the inclusion criteria for this study. The mean age at presentation was 14.3 ± 2.6 years (range, 3 to 18 years). The shoulder (NE = 43,207 [14.6%]), head (NE = 40,875 [13.8%]), and knee (NE = 30,218 [10.2%]) were the most injured body parts. The most common diagnoses were strain/sprain (NE = 91,924 [31%]), other/not stated (NE = 53,736 [18.1%]), and fracture (NE = 52,261 [17.6%]). Common mechanisms of injury included not specified (NE = 148,169 [50%]), impact with mat (NE = 61,557 [20.8%]), and abnormal rotation/strain (NE = 37,449 [12.6%]). Overall injuries ( P = .01) (coefficient: –1763 [95% CI, –2963 to −563]) and concussions ( P = .01) (coefficient: –178 [95% CI, –302 to −55]) statistically significantly decreased. Conclusions Our study showed a trend in the decrease in overall injuries and concussions in high school wrestlers. Strains/sprains were the most common diagnoses with the shoulder being the most common site. Youth wrestlers would benefit from future research analyzing risks associated with these injuries as well as advances in protective gear.

Two surgical approaches have emerged for axillary staging in cN1 breast cancer patients after neoadjuvant chemotherapy (NAC): sentinel lymph node biopsy (SLNB) and targeted axillary dissection (TAD). Direct comparisons of technical and oncological outcomes with SLNB versus TAD are lacking. We routinely performed SLNB from 2017 to 2018 for cN1 breast cancer patients who converted to cN0 after NAC, then adopted TAD from 2019 to 2022. To minimize the false-negative rate (FNR), we required retrieval of ≥3 sentinel lymph nodes (SLN) (2017–2018) or retrieval of the clipped node (CN) and ≥2 SLN (2019−2022). In ypN0 cases meeting these criteria, axillary lymph node dissection (ALND) was omitted. We compared the rate of per-protocol required ALND due to technical failure of SLNB versus TAD and reported axillary recurrence rates. Among 191 cN1 ypN0 patients, 77 underwent SLNB and 114 underwent TAD. The overall rate of required ALND due to technical failure was 14.7% and did not differ between SLNB versus TAD (16.9% vs. 13.2%, p = 0.38). The most common technical failure with SLNB was retrieving <3 SLN (10.4%); for TAD, it was not retrieving the CN (7.1%). Median follow-up was 3.9 years for SLNB patients and 1.7 years for TAD patients; there were 1 (1.3%) and 0 (0.0%) axillary recurrences, respectively. Sentinel lymph node biopsy and TAD for cN1 patients after NAC showed equivalent technical failure rates and low axillary recurrence rates. When applying strict criteria to minimize FNR of axillary staging surgery, approximately 15% of ypN0 patients may be overtreated with ALND.

This Perspective provides a crucial set of actions with corresponding recommendations aimed at propelling the physical therapy profession toward excellence in residency education. The conceptual model includes elements of excellence in the delivery and outcomes of physical therapist residency education and the domain of value experienced by stakeholders impacted by physical therapist residency education. Linked to the conceptual model, the 15 actions, and 28 recommendations draw from (1) the Physical Therapist Residency Excellence and Value (PT-REV) study, (2) the Physical Therapist Education for the 21st Century (PTE-21) study, and (3) research in the learning sciences. This paper proposes a transformative call for decisive and consistent reform directed toward residency programs, residents, sponsoring organizations, and the physical therapy profession. Physical therapist residency education, initiated over 23 years ago, is no longer in its infancy with critical gaps in its maturation that need to be addressed systematically by stakeholders across the profession, thus improving the profession’s ability to respond to changing societal needs. This Perspective serves as a call to action and provides specific recommendation for what is needed to promote and achieve excellence in physical therapist residency education to improve the professions’ ability to adapt to changing societal needs.

Objective A challenge in health professions is training practitioners to navigate health care complexities, promote health, optimize outcomes, and advance their field. Physical therapist residency education offers a pathway to meet these needs in ways that “entry-level” (professional) education may not. Identifying key aspects of excellence in residency education and understanding its value in developing adaptive expertise will help devise strategies to enhance program, resident, and patient outcomes. The objective of this study was to examine current physical therapist residency education practices to identify and describe examples of excellence and value. Methods A multi-site, multi-specialty qualitative case series was conducted, examining exemplary physical therapist residency programs and their contextual environments using a social constructivist theoretical lens. Six residency programs operating 20 individual residencies that were considered exemplar were selected for the study to participate in site visits. Qualitative case studies were generated from individual interviews, focus groups, review of artifacts, and field observations. The residencies were diverse in specialty area of practice, setting, and geographic location. Results A conceptual framework was generated grounded in the domains of excellence and value. These domains were connected by 3 signature indicators: (1) atmosphere of practice-based learning, (2) embodiment of professional formation, and (3) elevated practice. These signature indicators represent the aggregate effects of the interchange between the excellence and value domains which sustain residency education. Conclusion This study builds upon the work of the Physical Therapist Education for the 21st Century (PTE-21) study and identifies key elements of excellence in residency education, the value of such education, and related outcomes. Findings from this study substantiate the need for a postprofessional phase of physical therapist education founded in practice-based learning encapsulated in residency education. Impact Results from this study could have compelling and powerful implications on the dialogue and strategic direction in physical therapist residency education.

Anthropogenic debris has been documented in Antarctica for the past 40 years. Upon breakdown, large pieces become microdebris, which reaches the seafloor through a variety of physical and biological processes. The Antarctic benthos, deeply reliant on sinking organic particles, is thus vulnerable to ingesting microdebris. By using benthic specimens sampled between 1986 and 2016 and deposited in biological collections, we provide the first record of microdebris in Southern Ocean deep-sea invertebrates. Specimens from 15 species (n = 169 organisms) had their gut content examined, with 13 species yielding microdebris in the shape of fibers (n = 85 fibers). The highest ingestion percentages were recorded in the sea cucumbers Heterocucumis steineni (100%), Molpadia violacea (83%) and Scotoplanes globosa (75%), and in the brittle star Amphioplus peregrinator (53%). Deposit-and suspension-feeding were the strategies which yielded the most fibers, accounting for 83.53% of particles. Seven fibers were identified as microplastics, composed of polyamide, polycarbonate, polyester, polyethylene terephthalate, polyisoprene and polysulfone. We also provide the earliest record of a microplastic in Antarctica, a polysulfone fiber ingested by a Boreomysis sp. mysid caught in 1986. The occurrence of fibers in the world's most remote continental margin renews concerns of pollution in seemingly isolated regions.

The explosive growth of individuals identifying as multiracial in the U.S. population has motivated significant interest in multiracial face perception. Interestingly, the literature reveals stunningly low rates of classifications of multiracial faces as multiracial. Five studies examined the possibility that this lack of correspondence is rooted in perceptual confusion. To test this, we utilized multidimensional scaling and discriminant function analysis to determine how participants mentally represent multiracial faces relative to Latinx and monoracial faces. Studies 1–3 establish that multiracial faces are perceptually discriminable from non-multiracial faces using three different sets of facial stimuli: Asian–White female (Study 1), Black–White female (Study 2), and Asian–White male faces (Study 3). Study 4 examined whether mental representation was further moderated by sample demographics by comparing U.S. participants sampled from Hawaii and California. Finally, Study 5 tests the consistency of mental representations across individuals and rules out potential statistical artifacts associated with group multidimensional scaling. These studies provide consistent evidence that multiracial faces are perceptually distinct from Latinx and monoracial faces, suggesting that the categorization patterns of multiracial faces observed in past research likely stem from downstream processes rather than perceptual confusability of multiracial faces.

Acetaldehyde (CH3CHO) plays a crucial role in the synthesis of prebiotic molecules such as amino acids, sugars, and sugar‐related compounds, and in the progress of chain reaction polymerization in deep space. Here, we report the first formation of the cyclic acetaldehyde trimer – paraldehyde (C6H12O3) – in low‐temperature interstellar analog ices exposed to energetic irradiation as proxies of galactic cosmic rays (GCRs). Utilizing vacuum ultraviolet photoionization reflectron time‐of‐flight mass spectrometry and isotopic substitution experiments, paraldehyde was identified in the gas phase during the temperature‐programmed desorption of the irradiated acetaldehyde ices based on the calculated adiabatic ionization energies and isomer‐specific dissociative fragmentation patterns upon photoionization. As acetaldehyde is ubiquitous throughout the interstellar medium and has been tentatively identified in interstellar ices, paraldehyde could have formed in acetaldehyde‐containing ices in a cold molecular cloud and is an excellent candidate for gas‐phase observation in star‐forming regions via radio telescopes. The identification of paraldehyde in the gas phase from the processed acetaldehyde ices advances our understanding of how complex organic molecules can be synthesized through polymerization reactions in extraterrestrial ices exposed to GCRs.

This prologue to the NAEMSP Prehospital Trauma Compendium describes the rationale for and the process used in developing the compendium manuscripts. It also provides a summary of other contemporary works discussing additional elements of prehospital trauma care including hemorrhage control, airway and ventilation management, pain management, care for traumatic brain injury, and trauma triage.

Earth’s magnetic field exhibits a dominant dipole morphology. Notwithstanding, significant deviations from the dipole are evident today, particularly the South Atlantic Anomaly (SAA), characterized by anomalously low-field intensity and high directional variability, diminishing the field’s shielding effect. To assess the persistence of SAA-like features over multimillion-year scales, we combine paleomagnetic data from Trindade Island (20°30’S, 29°22’W) with an evaluation of paleosecular variation (PSV) over the past 10 Myr. We employ synthetic models to explore how the position and intensity of magnetic flux patches at the core-mantle boundary can influence the long-term field behavior. Here we present results that reveal anomalous field signatures in the South Atlantic and the Atlantic-Pacific hemispheric asymmetries are enduring features, likely linked to a bottom-up control of PSV by the inner core’s heterogeneities but with contributions from mantle anomalies in the long-time range.

The purpose of this study is to describe the development and initial validation of a survey focused on problematic situations involving e-cigarette use by rural Native Hawaiian and Pacific Islander (NHPI) youths. A 5-phase approach to test development and validation was used. In Phase 1 (Item Generation), survey items were created from a series of focus groups with middle school youths on Hawai‘i Island (N = 69). In Phase 2 (Item Refinement and Selection), situational items were reduced to 40 e-cigarette offer situations that were selected for inclusion in the survey. In Phase 3 (Item Reduction), items were administered to 257 youths from 11 middle, intermediate, or multi-level public or public-charter schools on Hawai‘i Island. Exploratory factor analysis indicated the presence of three factors accounting for 50% of the variance: E-Cigarette Offers from Friends (24%), E-Cigarette Offers from Non-Friends (16%), and Coercive Pressure to Use E-Cigarettes (10%). Hypothesized relationships between offer situations and e-cigarette use were partially confirmed, supporting the construct validity of the survey. This survey helps to fill the scientific and practice gap in measuring ecodevelopmental risk and protection for e-cigarette use and has implications for e-cigarette use prevention with rural, NHPI, and/or Indigenous youth populations.

Background Neoadjuvant chemotherapy (NACT) became a standard treatment strategy for patients with inflammatory breast cancer (IBC) because of high disease aggressiveness. However, given the heterogeneity of IBC, no molecular feature reliably predicts the response to chemotherapy. Whole-exome sequencing (WES) of clinical tumor samples provides an opportunity to identify genomic alterations associated with chemosensitivity. Methods We retrospectively applied WES to 44 untreated IBC primary tumor samples and matched normal DNA. The pathological response to NACT, assessed on operative specimen, distinguished the patients with versus without pathological complete response (pCR versus no-pCR respectively). We compared the mutational profiles, spectra and signatures, pathway mutations, copy number alterations (CNAs), HRD, and heterogeneity scores between pCR versus no-pCR patients. Results The TMB, HRD, and mutational spectra were not different between the complete (N = 13) versus non-complete (N = 31) responders. The two most frequently mutated genes were TP53 and PIK3CA. They were more frequently mutated in the complete responders, but the difference was not significant. Only two genes, NLRP3 and SLC9B1, were significantly more frequently mutated in the complete responders (23% vs. 0%). By contrast, several biological pathways involved in protein translation, PI3K pathway, and signal transduction showed significantly higher mutation frequency in the patients with pCR. We observed a higher abundance of COSMIC signature 7 (due to ultraviolet light exposure) in tumors from complete responders. The comparison of CNAs of the 3808 genes included in the GISTIC regions between both patients’ groups identified 234 genes as differentially altered. The CIN signatures were not differentially represented between the complete versus non-complete responders. Based on the H-index, the patients with heterogeneous tumors displayed a lower pCR rate (11%) than those with less heterogeneous tumors (35%). Conclusions This is the first study aiming at identifying correlations between the WES data of IBC samples and the achievement of pCR to NACT. Our results, obtained in this 44-sample series, suggest a few subtle genomic alterations associated with pathological response. Additional investigations are required in larger series.

Aquaculture, a rapidly expanding food production system, holds promise for improving global food security and resilience. However, imbalanced growth has led to a highly uneven distribution of aquaculture production among countries, a concern that has not been comprehensively examined. This paper fills this knowledge gap by developing an innovative indicator system to assess this issue based on aquaculture development in ~ 200 countries over five decades. The system utilizes the “effective number of countries” (ENC) as a basic measure of production distribution and extends it into two novel indicators, popularity and parity, to gauge inclusiveness and balance. The assessment from 1970 to 2020 reveals that aquaculture has become a global enterprise, operating in nearly 90% of countries. Nevertheless, there is still substantial potential for growth in aquaculture popularity across most of 43 species groups examined here. Regarding concerns over persistently imbalanced aquaculture growth, our assessment reveals that aquaculture parity increased during 1970–2020 in the majority of 85 country groups examined here, including 18 of 27 regions and subregions. Global parity is also on the rise in the new millennium (2000–2020). However, the global aquaculture parity remains considerably lower than those of capture fisheries and terrestrial meat production. This suggests that imbalanced global aquaculture development cannot be solely attributed to countries’ comparative advantages. This extraordinary imbalance could compromise global food security and food system resilience, but it also signifies untapped growth potential. Mainstreaming aquaculture popularity and parity as policy indicators can foster more inclusive and balanced development and unlock this potential. The proposed indicator system can be applied across diverse sectors and scales, contributing to a broader and refined understanding of the dynamics within the global food system.

Background Native Hawaiian and Pacific Islanders (NHPI) are disproportionately burdened by pregnancy-related deaths in the United States and have the lowest engagement in prenatal care compared to all other US racial groups. Aside from access barriers, studies suggest that NHPI face challenges with patient-clinician communication, perceived discrimination, and cultural conflicts within healthcare settings. This paper describes the cultural adaptation of the 14-item Mothers On Respect index for NHPI, originally developed by Vedam et al. (2017) for diverse communities in British Columbia, Canada, and reports the findings of the preliminary psychometric assessment of the adapted measure. Methods Data from 26 interviews with NHPI women, expert, and cognitive interviews were conducted to inform the adaptation. An online survey was administered to a sample of 90 NHPI women to assess construct validity, convergent validity, and internal reliability of the adapted measure using exploratory and confirmatory factor analyses. Results The adaptation resulted in substantial changes to the original measure, mainly by the addition of items related to ‘feeling cared for by and connected to the provider’ and ‘perceived threats hindering communication.’ The psychometric analyses identified a three-factor structure for the culturally adapted index and confirmatory factor analyses were employed to refine the measure. The result was a 25-item index with acceptable goodness of fit indices, high internal reliability (Cronbach’s alpha of 0.96, 95% CI = .94-.97) and convergent validity with a related scale. Overall, participants in this sample indicated high levels of respectful care; however, people who received < 8 prenatal care visits had significantly lower ratings on average. Conclusions Our findings suggest that the elements valued by NHPI are not fully captured in existing measures of respectful maternity care. Efforts to assess more discrete aspects of the patient-provider relationship for culturally distinct and racialized groups could help improve the quality of care and advance equity in maternal and perinatal health marginalized communities.

Despite extensive research supporting the effectiveness of mindfulness-based interventions, the understanding of the dynamic connections between various mindfulness facets, particularly across diverse cultures, remained limited. This study aimed to investigate the networks among mindfulness aspects across different cultural backgrounds and their individual associations with mental health and well-being. Using the data collected from 710 undergraduate students in Hawaii (445 Asian Americans, 265 European Americans), we constructed sparse networks for each group to investigate their centrality index. To compare the overall structures of these networks, we utilized permutation-based tests. In addition, we used relative weight analysis to evaluate the distinct contributions of each mindfulness facet to positive and negative mental health outcomes. The results indicated similar trends in both racial groups, emphasizing the importance of specific mindfulness aspects like describing and acting with awareness within the mindfulness construct. However, notable variations were observed, particularly in how observing and nonjudging facets related among Asian Americans. In addition, acting with awareness and nonjudging showed substantial inverse associations with negative mental health outcomes across groups, whereas the observing aspect displayed positive connections with anxiety and stress among Asian Americans. The findings suggest which aspects are fundamental to mindfulness, aiding in a nuanced understanding of the construct. They also emphasize the importance of acknowledging cultural diversity in both mindfulness research and its clinical applications. Practical implications and directions for future research were discussed.

Background Combination immune checkpoint blockade targeting PD-1 and CTLA-4 leads to high response rates and improved survival in advanced cutaneous melanoma (CM). Less is known about the efficacy of this combination in acral lentiginous melanoma (ALM). Objectives To determine the efficacy of combination immune checkpoint blockade targeting PD-1 and CTLA-4 in a real-world, diverse population of ALM. Methods This multi-institutional retrospective study analyzed patients with histologically confirmed ALM treated with the combination of PD-1 and CTLA-4 inhibitors between 2010-2022. The primary objective of the study was objective response rate (ORR) per RECIST criteria. The secondary objectives were progression-free survival (PFS) and overall survival (OS). Results In total, 109 patients with advanced ALM treated with combined PD-1 and CTLA-4 blockade in any line of treatment were included. The majority of patients had stage IV disease (n=81, 74.2%). The ORR for the entire cohort was 18.3% (95% CI 11.6-26.9%), with 9 (8.3%) complete responses (CR) and 11 (10.1%) partial responses (PR). An additional 22 patients (20.2%) had stable disease (SD), and the disease control rate (DCR) was 38.5%. The median PFS was 4.2 months [95% CI 3.25-5.62], while the median OS was 17 months [95% CI 12.4%-23.1%]. A total of 95 patients (87.2%) had a treatment-related adverse event, with 40.4% (n=44/109) experiencing at least one grade 3 or 4 toxicity. Elevated LDH (p=.04), 2+ lines of prior therapy (p=.03), and Asian race/ethnicity (p=.04) were associated with worse OS, while Hispanic/Latino race/ethnicity was associated with better OS (p=.02). Conclusions Combination of PD-1 and CTLA-4 blockade is less effective for ALM, as compared to CM, despite similar toxicity. Asian patients, in particular, appear to derive lower benefit from this regimen. Novel treatment approaches are needed for this rare melanoma subtype.

Buildings consume about 30% of the world's energy, and produce 37% of global energy-related CO ₂ emissions. Building energy efficiency is becoming even more critical as climate change related events take a toll on human life, and further increase building energy consumption due to higher cooling needs. Reducing building energy consumption is imperative to break this detrimental cycle of harmful emissions creating more energy demand. Occupancy sensors play a crucial role in building energy efficiency by optimizing the operation of lighting, heating, ventilation, air conditioning (HVAC) and other systems based on the presence or absence of people. Microwave radar-based occupancy sensors offer improved accuracy, versatility, and coverage range over other occupancy sensors, while remaining non-intrusive and low-cost. However, building energy savings from usage of radar-based occupancy sensors has not been widely documented. Here, we show that microwave occupancy sensors, installed in an academic office building in Hawai'i can be used to manage HVAC schedules, ultimately providing energy savings of over 6 kWh/yr/sf, about 20% reduction in energy usage for this building. These results demonstrate how controlling energy consumption based on microwave occupancy sensing can greatly reduce building energy consumption which is crucial for controlling climate change.

The well-being of people working and studying in higher education, including students, staff, and faculty, is a topic of increasing concern. The lack of well-being may be attributed to the current academic context, which does not consistently provide cues that affirm social inclusion to all members of the academic population. This study examines the role of kindness (defined as actions that affirm dignity and social inclusion) in promoting identification with community and well-being in higher education utilizing a cross-sectional study of 182 diverse members of higher education. To assess the extent that kindness relates to the acquisition of institutional identity, well-being, and stress, we developed and validated two novel psychometric rating scales for kindness: Kindness Received (α = 0.927, ώ = .921) and Kindness Given (α = .859, ώ = .860). Initial analysis showed that receiving kindness was significantly associated with increased well-being, reduced stress, and improved institutional identity. Giving kindness was significantly associated with decreased stress reduction and decreased institutional identity. Results from structural equation modeling shows that institutional identity mediates the relationship between receiving kindness and well-being. Qualitative analysis of micronarratives regarding kindness showed that feeling safe and being acknowledged are the most commonly described experiences of kindness, both acts that affirm dignity. The findings from this study suggests that kindness contributes towards improving diverse people’s well-being and increased identification with institutions of higher education. Measurement of kindness provides methods for assessing institutional changes that foster greater positivity and inclusion in higher education settings.