UNASSIGNED: Due to their medical and technology dependence, families of children with medical complexity (CMC) have significant costs associated with care. Financial impact on families in general have been described, but detailed exploration of expenses in specific categories has not been systematically explored. Our objective was to describe out-of-pocket (OOP) expenses incurred by caregivers of CMC and to determine factors associated with increased expenditures.
UNASSIGNED: This is a secondary observational analysis of data primary caregiver-reported OOP expenses as part of a randomized control trial conducted in Ontario, Canada. Caregivers completed questionnaires reporting OOP costs. Descriptive statistics were utilized to report OOP expenses and a linear regression model was conducted.
UNASSIGNED: 107 primary caregivers of CMC were included. The median (IQR) age of participants was 34.5 years (30.5 to 40.5) and 83.2% identified as the mother. The majority were married or common-law (86.9%) and 50.5% were employed. The participant\'s children [median (IQR) age 4.5 (2.2 to 9.7); 57.9% male] most commonly had a neurological/neuromuscular primary diagnosis (46.1%) and 88% utilized medical technology. Total OOP expenses were $8,639 CDN annually (IQR = $4,661 to $31,326) with substantial expenses related to childcare/homemaking, travel to appointments, hospitalizations, and device costs. No factors associated with greater likelihood of OOP expenses were identified. A P-value of <0.05 was considered significant.
UNASSIGNED: Caregivers of CMC incur significant OOP expenses related to the care of their children resulting in financial burden. Future exploration of the financial impact on caregiver productivity, employment, and identification of resources to mitigate OOP expenses will be important for this patient population.

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Despite their inclusion as first-line therapy for many chronic diseases, lifestyle interventions are often de-emphasized in medical education and fail to make it into the repertoire of non-lifestyle medicine trained clinicians. We sought to address this gap in medical education by creating a concise pocket guide to lifestyle medicine that lends itself to use in the face-to-face clinical setting. With input from lifestyle medicine experts, the guide was created by medical students for medical students as well as other healthcare professionals for use in a variety of clinical settings. In this article we share our process of creating the guide, initial feedback, and future directions.

BACKGROUND: While vascular puncture is always performed before making port pocket in the implantation of totally implantable venous access ports (TIVAP), some surgeons preferred to make port pocket first. This study seeks to verify the safety and feasibility for the pocket-first technique.
METHODS: The study retrospectively reviewed 447 patients who undergone TIVAP implantation from July 2017 to November 2022. All the patients were divided into two groups based on vascular puncture first or making port pocket first. The general information, operation information and post-operative complications were reviewed and analyzed.
RESULTS: All the operations were performed successfully. No difference was observed in the sex, age, height, weight, BMI, port location and total complication rate between the two groups. The operation time of the Puncture Group and the Pocket Group were 46.9 ± 22.4 min and 33.8 ± 13.6 min ( P<0.00001 ). In the patients of SCV approach, the operation time between the two groups were 37.4 ± 14.8 min and 33.5 ± 10.9 min ( P<0.05 ). Multivariate analysis showed the variable BMI and first procedure were independent prognostic factors for operation time. In the cases using SCV/AxV approach the variable first procedure was the only independent prognostic factor for operation time (P = 0.002).
CONCLUSIONS: The pocket-first technique can be considered as a safe, feasible and convenient technique for TIVAP implantation. The time consuming is significantly shortened compared with the puncture-first technique and this advantage may be more obvious when using SCV/AxV approach.

UNASSIGNED: To assess the function of platelet-rich plasma (PRP) both only and in combination with bioactive glass in intrabony defects.
UNASSIGNED: Twenty patients were split into two groups with 10 samples each: group I with PRP alone, whereas group II was done with PRP in addition to bioactive glass. Following local anesthesia, full-thickness mucoperiosteal flaps were elevated in the afflicted site, the defect was debrided, and root planning with curettes was performed. Irrigation was then used while in group II- PRP along with bone graft (BG) preservationwas done. Suturing in group I was contained. At day 0 (baseline) and 6 months after surgery, the clinical parameters for probing depth, clinical attachment stage, and radiographic assessment were noted for both groups.
UNASSIGNED: When comparing both groups, there was no statistically considerable variation. However, the intragroup comparison for pocket depth and clinical attachment level between baseline and 6 months was significant. Radiographic bone level was not considerably dissimilar across groups; however, it was significantly different between groups.
UNASSIGNED: Reduced probing depth, higher clinical attachment level, and radiographic evidence of bone fill are clinical outcome measures that are associated with effective regenerative therapy.

Kirsten rat sarcoma virus oncogene homolog (KRAS) is the most frequently mutated oncogene in human cancer. In colorectal cancer (CRC), KRAS mutations are present in more than 50% of cases, and the KRAS glycine-to-cysteine mutation at codon 12 (KRAS G12C) occurs in up to 4% of patients. This mutation is associated with short responses to standard chemotherapy and worse overall survival compared to non-G12C mutations. In recent years, several KRAS G12C inhibitors have demonstrated clinical activity, although all patients eventually progressed. The identification of negative feedback through the EGFR receptor has led to the development of KRAS inhibitors plus an anti-EGFR combination, thus boosting antitumor activity. Currently, several KRAS G12C inhibitors are under development, and results from phase I and phase II clinical trials are promising. Moreover, the phase III CodeBreaK 300 trial demonstrates the superiority of sotorasib-panitumumab over trifluridine/tipiracil, establishing a new standard of care for patients with colorectal cancer harboring KRAS G12C mutations. Other combinations such as adagrasib-cetuximab, divarasib-cetuximab, or FOLFIRI-panitumumab-sotorasib have also shown a meaningful response rate and are currently under evaluation. Nonetheless, most of these patients will eventually relapse. In this setting, liquid biopsy emerges as a critical tool to characterize the mechanisms of resistance, consisting mainly of acquired genomic alterations in the MAPK and PI3K pathways and tyrosine kinase receptor alterations, but gene fusions, histological changes, or conformational changes in the kinase have also been described. In this paper, we review the development of KRAS G12C inhibitors in colorectal cancer as well as the main mechanisms of resistance.

Portable handheld devices based on near-infrared (NIR) technology have improved and are gaining popularity, even if their implementation in milk has been barely evaluated. Thus, the aim of the present study was to assess the feasibility of using short-wave pocket-sized NIR devices to predict milk quality. A total of 331 individual milk samples from different cow breeds and herds were collected in 2 consecutive days for chemical determination and spectral collection by using 2 pocket-sized NIR spectrophotometers working in the range of 740 to 1,070 nm. The reference data were matched with the corresponding spectrum and modified partial least squares regression models were developed. A 5-fold cross-validation was applied to evaluate individual device performance and an external validation with 25% of the dataset as the validation set was applied for the final models. Results revealed that both devices\' absorbance was highly correlated but greater for instrument A than B. Thus, the final models were built by averaging the spectra from both devices for each sample. The fat content prediction model was adequate for quality control with a coefficient of determination (R2ExV) and a residual predictive deviation (RPDExV) in external validation of 0.93 and 3.73, respectively. Protein and casein content as well as fat-to-protein ratio prediction models might be used for a rough screening (R2ExV >0.70; RPDExV >1.73). However, poor prediction models were obtained for all the other traits with an R2ExV between 0.43 (urea) and 0.03 (SCC), and a RPDExV between 1.18 (urea) and 0.22 (SCC). In conclusion, short-wave portable handheld NIR devices accurately predicted milk fat content, and protein, casein, and fat-to-protein ratio might be applied for rough screening. It seems that there is not enough information in this NIR region to develop adequate prediction models for lactose, SCC, urea, and freezing point.

Double-layered flat bread features an impressive oven rise and delamination during baking, leading to the formation of an internal pocket capable of holding various solid foods - a key quality criterion for consumers. These breads are unique in their baking method, which requires specialized ovens and high temperatures between 350 and 550 °C. Use of high baking temperatures to achieve the double layering development (called delamination) during baking has raised concerns over excessive energy consumption. In this study, whether or not the application of fermentation (affecting the accumulation of dissolved CO2) and baking temperature (which affects gas generation) were varied and the impacts on delamination were evaluated. To complement this evaluation, dough water content and temperature were monitored during baking. In a novel manner, this study characterized water distribution in flat bread, explaining the surprising decrease of water loss with increasing baking temperature. Our study has clearly shown water vapor to be the prime cause of delamination. The role of water pressure in dough inflation and in causing the edges to detach from the deck and the heterogeneity of flat bread water content were highlighted and a concept map proposed.

UNASSIGNED: An escalation in cases of rhinomaxillary mucormycosis among post-COVID patients is being reported. However, there is limited information about periodontal features in mucormycosis cases. This study explored the periodontal signs and symptoms among post-COVID mucormycosis individuals.
UNASSIGNED: This cross-sectional study was carried out with a total of 25 post-COVID mucormycosis patients attending tertiary care public teaching hospital. Clinical and radiographic assessments were done.
UNASSIGNED: An elevation in mean probing pocket depth (PPD) up to 6.21 ± 2.7 mm was noted. Nearly 16%-40% of patients had Miller\'s Grade III mobility in the affected site. Forty-four per cent had localized single or multiple abscess, 40% had palatal swelling, 32% had necrosis of soft tissue and bone exposure, and 52% had maxillary dentoalveolar segmental mobility in the affected site. Radiographic examination revealed varying stages of interdental bone loss.
UNASSIGNED: The present study observed an increase in mobility and mean PPD which did not commiserate with interdental bone loss in the affected maxillary region.