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The water relations and hydraulic architecture of a tropical tree (Schefflera morototoni) and of two temperate species (Acer saccharum and Thuja occidentalis) are reported. Among the water relations parameters measured were leaf and stem water storage capacity leaf water potential, transpiration, and vulnerability of stem to cavitation and loss of hydraulic conductivity by embolisms. Among the hydraulic architecture parameters measured were hydraulic conductivity per unit pressure gradient, specific conductivity, leaf-specific conductivity, and Huber value. In terms of vulnerability of stems to cavitation, stem and leaf capacitances, and leaf-specific conductivity, all three species followed the same sequence: Schefflera Acer Thuja. It is argued here that the high stem capacitance and high leaf-specific conductivity of Schefflera are necessary to compensate for its high vulnerability to cavitation. Extractable water storage per unit leaf area in Schefflera stems is 100 times that of Acer and may permit the species to survive unusually long, dry seasons in Panama. Although Schefflera frequently grows 20 meters, the biggest resistance to water flow in the shoots resides in the leaves

Health literacy includes a set of skills needed to make appropriate health decisions and successfully navigate the health care system. These skills include reading, writing, numeracy, communication, and, increasingly, the use of electronic technology. National data indicate that more than one-third of U.S. adults have limited health literacy, which contributes to poor health outcomes and affects patient safety, and health care access and quality. Although there are a number of tools that screen for limited health literacy, they are primarily used for research. Routinely screening patients for health literacy has not been shown to improve outcomes and is not recommended. Instead, multiple professional organizations recommend using universal health literacy precautions to provide understandable and accessible information to all patients, regardless of their literacy or education levels. This includes avoiding medical jargon, breaking down information or instructions into small concrete steps, limiting the focus of a visit to three key points or tasks, and assessing for comprehension. Additionally, printed information should be written at or below a fifth- to sixth-grade reading level. Visual aids, graphs, or pictures can enhance patient understanding, as can more concrete presentation of numerical information.

1. Variation in late-winter xylem embolism, phenological traits, growth parameters, xylem anatomy and allozyme characteristics were examined in four populations of European beech (Fagus sylvatica) from different geographical origins in Italy. 2. Ultrasonic acoustic emissions from plant stems were measured during winter. Late-winter xylem embolism was quantified before budburst. The timing of budburst was recorded and plant growth parameters were monitored during the spring. The dimension and density of xylem conduits were measured. The genetic variability was investigated using isoenzymes as genetical markers. 3. Significant differences between populations in the rate of acoustic emissions, late-winter embolism, phenological traits and spring growth parameters were observed. Xylem embolism was higher in populations that displayed a higher rate of acoustic emissions during winter. The most embolized population displayed later budburst and slower growth in the spring. No significant differences in xylem anatomy were found. 4. Six out of 10 isoenzymatic loci showed significantly different allele frequencies between populations, but no clear association was found between the genetic variation and the variation of the other traits investigated.

The mental status examination is an essential tool that aids physicians in making psychiatric diagnoses. Familiarity with the components of the examination can help physicians evaluate for and differentiate psychiatric disorders. The mental status examination includes historic report from the patient and observational data gathered by the physician throughout the patient encounter. Major challenges include incorporating key components of the mental status examination into a routine office visit and determining when a more detailed examination or referral is necessary. A mental status examination may be beneficial when the physician senses that something is “not quite right” with a patient. In such situations, specific questions and methods to assess the patient's appearance and general behavior, motor activity, speech, mood and affect, thought process, thought content, perceptual disturbances, sensorium and cognition, insight, and judgment serve to identify features of various psychiatric illnesses. The mental status examination can help distinguish between mood disorders, thought disorders, and cognitive impairment, and it can guide appropriate diagnostic testing and referral to a psychiatrist or other mental health professional.

Objective To evaluate whether implementation of the Michigan Keystone ICU project, a comprehensive statewide quality improvement initiative focused on reduction of infections, was associated with reductions in hospital mortality and length of stay for adults aged 65 or more admitted to intensive care units.Design Retrospective comparative study, using data from Medicare claims.Setting Michigan and Midwest region, United States.Population The study period (October 2001 to December 2006) spanned two years before the project was initiated to 22 months after its implementation. The study sample included hospital admissions for patients treated in 95 study hospitals in Michigan (238 937 total admissions) compared with 364 hospitals in the surrounding Midwest region (1 091 547 total admissions).Main outcome measures Hospital mortality and length of hospital stay.Results The overall trajectory of mortality outcomes differed significantly between the two groups upon implementation of the project (Wald test χ2=8.73, P=0.033). Reductions in mortality were significantly greater for the study group than for the comparison group 1-12 months (odds ratio 0.83, 95% confidence interval 0.79 to 0.87 v 0.88, 0.85 to 0.90, P=0.041) and 13-22 months (0.76, 0.72 to 0.81 v 0.84, 0.81 to 0.86, P=0.007) after implementation of the project. The overall trajectory of length of stay did not differ significantly between the groups upon implementation of the project (Wald test χ2=2.05, P=0.560). Group differences in adjusted length of stay compared with baseline did not reach significance during implementation of the project (−0.45 days, 95% confidence interval −0.62 to −0.28 v −0.35, −0.52 to −0.19) or during post-implementation months 1-12 (−0.59, −0.80 to −0.37 v −0.42, −0.59 to −0.25) and 13-22 (−0.67, −0.91 to −0.43 v −0.54, −0.72 to −0.37).Conclusions Implementation of the Keystone ICU project was associated with a significant decrease in hospital mortality in Michigan compared with the surrounding area. The project was not, however, sufficiently powered to show a significant difference in length of stay.

Suicidal ideation is increasing among university students. Despite growing demand for services, university counseling centers (UCCs) face limited resources to meet the complex needs of students who are suicidal. The Comprehensive Adaptive Multisite Prevention of University Student Suicide (CAMPUS) Trial evaluates 4 treatment sequences within UCCs to develop evidence-based treatment guidelines. The CAMPUS Trial consists of a feasibility study followed by a sequential multiple-assignment randomized trial (SMART). The original CAMPUS protocol was modified during the COVID-19 pandemic to accommodate new UCC tele-mental health services, including remote treatment, assessments, and monitoring. A smaller-scale feasibility study was conducted to (1) evaluate implementation of hybrid telehealth and in-person interventions and (2) fine-tune online procedures. Following the feasibility study, university students (aged 18-25 years) seeking UCC services with moderate to severe suicidal ideation will enroll in the CAMPUS Trial. Student participants are randomly assigned to 1 of 4 treatment sequences with 2 stages of intervention. In stage 1, students receive 4 to 6 weeks of either (1) a suicide-focused treatment-Collaborative Assessment and Management of Suicidality-or (2) enhanced treatment as usual. Treatment responders enter the maintenance phase. In stage 2, nonresponders are rerandomized for an additional 1 to 8 weeks of (1) Collaborative Assessment and Management of Suicidality or (2) an intensive skills-based treatment-dialectical behavior therapy for UCC settings. UCC counselors will enroll in the CAMPUS Trial to complete measures about their experience working with students who are suicidal. CAMPUS Trial administration includes representation from all sites to facilitate cross-site coordination and an advisory board of stakeholders from all UCCs to facilitate treatment implementation. Student participant recruitment began on October 25, 2022, and ended on May 16, 2024. As of November 2024, data collection for the SMART was ongoing with active study participants. Data collection was completed in November 2024, and as of April 2025, data analysis is underway. Full results will be available in 2025. The CAMPUS Trial offers a model for future SMARTs for the treatment of suicidal thoughts or behaviors (or both) across various settings. The results will inform treatment guidelines for students presenting with suicidality at UCCs. ClinicalTrials.gov NCT04707066; http://clinicaltrials.gov/ct2/show/NCT04707066. DERR1-10.2196/68441.

The vidian nerve is a landmark for safe identification of the petrous internal carotid artery during endonasal endoscopic approaches (EEAs) to the skull base. The surgical technique classically described involves sacrifice of the nerve. To demonstrate the feasibility of vidian nerve transposition during EEA. After exposure of the vidian canal aperture, the bone is removed along its inferior and medial aspect. Once the depth is understood, determining the position of the internal carotid artery, the bone superior to the vidian nerve is drilled. The vidian nerve can then be transposed from its canal and retracted superiorly, allowing the drill to come inferiorly and to remove the bone lateral to the nerve, finalizing freedom around the vidian nerve. Four patients underwent EEA with vidian transposition. a 20-year-old woman presented with partial numbness on the left side of the face and some tingling in the face, particularly inside her mouth. Magnetic resonance imaging scans demonstrated a Meckel cave tumor compatible with a left-side trigeminal schwannoma. EEA to the Meckel cave was performed and the vidian nerve was transposed. The tumor was totally resected and the vidian nerve preserved. The patient was discharged home in 2 days, stating improvement in facial sensation without new neurological deficits and denying dry eye. The patient was asymptomatic at the 9-month follow-up. None of the 4 patients who underwent this procedure complained of dry eye during the postoperative period. The vidian nerve transposition for EEAs to the skull base is an alternative technique that is feasible and conservative. It seems to be a good option that could prove beneficial to the quality of life of patients after surgery.

Olfactory neuroblastomas are uncommon malignancies that arise from olfactory receptor cells located high in the nasal cavity. Accurate diagnosis plays a crucial role in determining clinical results and guiding treatment decisions. Diagnosis can be a major challenge for pathologists, especially when dealing with tumours with poor differentiation. The discovery of several molecular and immunohistochemical markers would help to overcome classification difficulties. Due to the paucity of large-scale studies, standardisation of diagnosis, treatment and prediction of outcome remains a challenge. Surgical resection by endoscopic techniques with the addition of postoperative irradiation is the treatment of choice. In addition, it is advisable to consider elective neck irradiation to minimise the risk of nodal recurrence. Molecular characterisation will help not only to make more accurate diagnoses but also to identify specific molecular targets that can be used to develop personalised treatment options tailored to each patient. The present review aims to summarise the current state of knowledge on histopathological diagnosis, the molecular biology and management of this disease.

Abstract BACKGROUND Purely ventral foramen magnum meningiomas are challenging tumors to treat given their location, and proximity and relationship to vital neurovascular structures. OBJECTIVE To present endoscopic endonasal surgery (EES) as a complementary approach to the far-lateral suboccipital approach (FLA) for ventral midline tumors. METHODS From May 2008 to October 2013, 5 patients underwent EES and 5 FLA for primary ventral foramen magnum meningiomas. We retrospectively reviewed their records to evaluate outcomes. RESULTS Nine of 10 patients presented with long-tract and lower cranial nerve deficits. All patients who presented with deficits preoperatively completely normalized after tumor resection regardless of approach. Gross total resection was achieved in 2 cases in the EES group and 4 cases in the FLA group (the rest were near total). Vascular encasement was a limitation to gross total resection with both approaches. Preoperative median Karnofsky Performance Scale score was 80 and improved to 100 in both groups. Following EES, 1 patient developed cerebrospinal fluid leak with resultant meningitis. Two patients developed hydrocephalus, one of which developed an epidural abscess following necrosis of the nasoseptal flap, requiring debridement. In the FLA group, 1 patient developed a pseudomeningocele associated with hydrocephalus. One patient developed an abdominal fat graft site hematoma. CONCLUSION Both approaches provide excellent results for resection of ventral foramen magnum meningiomas, with reconstruction and hydrocephalus as the main sources of complication. In our practice, EES is a preferred technique in ventral, purely midline tumors with limited inferior extension and reduced lower cranial nerve manipulation, whereas FLA is preferred in tumors with lateral and caudal extension below the tip of the dens.