**Abstract:**

Kin-based social institutions (KBSI) shape human social networks, norms of property ownership, and marriage patterns, among other things, and have played an important role in the evolution of human psychology and social systems. Among the Karo of Indonesia, the rate of preferential matrilateral cross-cousin (impal) marriage, one of the most important KBSIs for that society, decreased drastically from at least the first half of the 20th century to recent times. We used a sample of 176 marriages from 62 villages and epidemiological methods (case-control study design and structural equation modeling) to measure the effect of various risk factors for impal marriage. With 88 cases (individuals ever married to their impal) and 88 controls (those never married to impal) matched by sex and age, we built models to assess risk factors in five groupings related to demography, religion, alliance, co-socialization, and modernization. There were significant factors with direct or indirect effects on the risk of impal marriage in four of the five groupings. Our results have implications for understanding the role of various factors on the decline of impal marriage among the Karo, but also for understanding the dynamics of social change and cultural evolution more generally.

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Twitter: @gkushnick

LIVE - Explaining the decline of preferential matrilateral cross-cousin (impal) marriage among the Karo of Indonesia: An epidemiological approach to cultural evolution

Depressive disorders constitute a severe public health issue worldwide. However, public health systems have limited capacity for case detection and diagnosis. In this regard, the widespread use of social media has opened up a way to access public information on a large scale. Computational methods can serve as support tools for rapid screening by exploiting this user-generated social media content. This paper presents an efficient semantic pipeline to study depression severity in individuals based on their social media writings. We select test user sentences for producing semantic rankings over an index of representative training sentences corresponding to depressive symptoms and severity levels. Then, we use the sentences from those results as evidence for predicting symptoms severity. For that, we explore different aggregation methods to answer one of four Beck Depression Inventory (BDI-II) options per symptom. We evaluate our methods on two Reddit-based benchmarks, achieving improvement over state of the art in terms of measuring depression level.

Semantic Similarity Models for Depression Severity Estimation | VIDEO

We present Dolphin, a novel benchmark that addresses the need for a natural language generation (NLG) evaluation framework dedicated to the wide collection of Arabic languages and varieties. The proposed benchmark encompasses a broad range of 13 different NLG tasks, including dialogue generation, question answering, machine translation, summarization, among others. Dolphin comprises a substantial corpus of 40 diverse and representative public datasets across 50 test splits, carefully curated to reflect real-world scenarios and the linguistic richness of Arabic. It sets a new standard for evaluating the performance and generalization capabilities of Arabic and multilingual models, promising to enable researchers to push the boundaries of current methodologies. We provide an extensive analysis of Dolphin, highlighting its diversity and identifying gaps in current Arabic NLG research. We also offer a public leaderboard that is both interactive and modular and evaluate several Arabic and multilingual models on our benchmark, allowing us to set strong baselines against which researchers can compare.

Dolphin: A Challenging and Diverse Benchmark for Arabic NLG

In very recent years more attention has been placed on probing the role of pre-training data in Large Language Models (LLMs) downstream behaviour. Despite the importance, there is no public tool that supports such analysis of pre-training corpora at large scale. To help research in this space, we launch Koala, a searchable index over large pre-training corpora using lossless compressed suffix arrays with highly efficient compression rate and search support. In its first release we index the public proportion of OPT 175B, GPT-3, GPT-Neo, GPT-Neo, LLaMA, BERT, ELECTRA, RoBERTA, XLNet pre-training corpora. Koala provides a framework to do forensic analysis on the current and future benchmarks as well as to assess the degree of memorization in the output from the LLMs. Koala is available for public use at https://koala-index.erc.monash.edu/.

Koala: An Index for Quantifying Overlaps with  Pre-training Corpora

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) is a rare congenital anomaly that is characterized by the triad of uterus didelphys, obstructed hemivagina, and ipsilateral renal dysplasia. It is also known as Herlyn-Werner-Wunderlich syndrome. 

OHVIRA is typically diagnosed after menarche and is often associated with recurrent severe dysmenorrhea and vague lower abdominal pain, although the presentation can be variable. Due to the normal onset of menarche from the non-obstructed side, diagnosis of OHVIRA can easily be missed, which can lead to complications such as infection, pelvic inflammatory disease, and endometriosis. 

In this report, we present a case of OHVIRA syndrome in a 16-year-old girl who presented with lower abdominal pain and constipation. This case underscores the importance of maintaining a high index of suspicion for OHVIRA syndrome in adolescents with non-specific abdominal or pelvic symptoms.



When Constipation is More than Just Constipation: A Rare Case of OHVIRA Syndrome

Background
Studies have shown that food-insecure households are two to three times more likely to develop diabetes. The increasing prevalence of diabetes has resulted in significant costs in both government healthcare spending and annual costs for diabetic patients. Additionally, food insecurity among diabetic patients has been shown to contribute to the progression of diabetes and the development of complications like chronic kidney disease, which worsen health outcomes and result in billions more in annual healthcare spending.
Uninsured diabetic patients face additional significant barriers to care and have limited access to primary care services, which can result in poor glycemic control and subsequent advanced disease and comorbidities. As a result, this patient population often relies on safety net programs like Federally Qualified Health Centers and emergency department visits to receive care. However, the use of emergency department services has contributed to rising annual healthcare costs and poses a significant strain on emergency departments, especially in the communities that serve them.

Case Presentation
Increasing the geographical density of FQHCs has been found to reduce emergency department visits among uninsured patients, may reduce uncompensated costs incurred by uninsured diabetics, and provide a pathway for earlier intervention. Some additional strategies to mitigate the prevalence of diabetes have been the implementation of Community Health Workers (CHWs), which has been shown to be a cost-effective strategy to improve diabetes management and reduce emergency room visits. More recently, there have been several initiatives by the White House and USDA to mitigate food insecurity through "food as medicine" prescription programs. Though these various strategies and resources have been shown to reduce costs and improve patient outcomes, siloed efforts, the temporary nature of these programs, and lack of sustainability have been cited as barriers.

Discussion
Therefore, I propose an increase in the geographical density of Federally Qualified Health Centers, increased implementation of community health workers, and expansion of existing federal nutrition assistance grant programs to address the prevalence of diabetes and food insecurity. Additionally, implementing on-site food pantries would be especially important in FQHCs that serve uninsured patients who face significant barriers to transportation and may not qualify for federal programs like SNAP. These strategies can not only improve health outcomes but may reduce overall healthcare spending on diabetes, minimize uncompensated care costs, and mitigate spending on other chronic disease complications caused by diabetes, like chronic kidney disease.

Addressing Diabetes and Food Insecurity: Community Health Workers and Clinic Based Food Referral Programs

Infertility impacts 1 in 4 female physicians which is twice a s high in comparison to the women in the general population. As the proportion of women in the medical workforce
continues to rise, it becomes crucial to address reproductive health issues for female physicians. This study aims to a s s e s s medical students' knowledge of fertility, risk factors for infertility, and available treatment options.

Assessing Medical Students' Understanding of Fertility and Infertility: Implications for Physician Well-being and Reproductive Health

Background
Neurosurgery residency is a fast-paced, time-consuming entity, which results in residents commonly approaching, if not violating the 80-hour workweek limit. This involves a complex structure with multiple hospitals, services, and clinic days, leading to challenges in creating fair call schedules. Historically, the manually-prepared scheduling system by the chief resident has been prone to biases, mistakes, and perceived unfairness. To address these issues, an automated and optimized neurosurgery scheduling system (AONSS) has been developed to reduce biases, accommodate resident requests, and optimize call variation, ultimately enhancing the educational experience by promoting diverse junior-senior-attending relationships. Of note, the national neurosurgery residency pool is reported to be ~18% female. 

Methods
AONSS was built using a combination of Perl and Visual Basic. The inaugural use of the AONSS occurred on July 1, 2021, in an optional manner, to the chiefs during the 2021-2022 academic year. An updated version of the program was implemented July 1, 2022 for the 2022-2023 academic year. Residents were surveyed using Google Forms with anonymous responses prior to its implementation and again as a follow up in July 2023. Objective primary outcome measure: senior and junior call variation (variance); Objective secondary outcome measures: variation in senior and junior Saturday call, senior and junior weekend call, senior-junior pairings, and resident-attending pairings. Subjective primary outcome measure: perceived satisfaction score based on 5-point Likert scale; Subjective secondary outcome measures: perceived fairness score (5-point Likert scale), perceived gender-bias (dichotomous) and perceived racial-bias (dichotomous).

Results
26 residents (28-39% female/year) were included in the study. AONSS was used for 6/13 blocks during the 2021-2022 academic year and 13/13 blocks for the 2022-2023 academic year. Overall call variation reduced by 70%. All other objective secondary measures have improved with AONSS. Monthly duty hours were reduced and less varied. Satisfaction scores improved from 21% reporting being somewhat satisfied or very satisfied to 90%. Fairness scores improved from 43% reporting being somewhat fair or very fair to 95%. Perception of gender bias decreased from 29% to 0%. No resident felt there was racial bias in either system.

Conclusion

Our newly developed automated scheduling system effectively reduces variation among calls in the complex UF neurosurgery residency, which in return, was found to increase residents’ satisfaction with their schedule, improve their perception of fairness with the schedule, and has completely removed the perception of sexual bias in a program that has a large percentage of females. Additionally, it was found to be associated with a decrease in duty hours. 


Automated and Optimized Neurosurgery Scheduling System Improves Resident Satisfaction

Background: Mental illnesses following an ICU stay are prevalent among patients and can be triggered by physical and emotional stress associated with critical illness, compounded by invasive procedures and sedatives administered in the ICU setting. Despite their frequency, these conditions are often not recognized or addressed in the ICU setting. However, in recent years, the mental health outcomes of patients who have survived an ICU stay have been a growing concern, and evolving methodologies are on the ascent particularly in European countries. The goal of this study is to assess the efficacy of existing methods for prevention of post-ICU mental health disorders and to analyze advancing techniques implemented in other countries.
Methods: This study employed a systematic literature review utilizing PubMed, EMBASE, and Wiley online databases to investigate the mental health outcomes linked to ICU experiences and the efficacy of current methods of prevention.
Results: Mental health conditions are frequently observed in patients following an ICU stay, with anxiety occurring in 12% to 43%, depression in 10% to 30%, and PTSD in 64% of patients. Current preliminary approaches to prevention include ICU journals, psychological counseling, and follow-up care in outpatient settings. The aforementioned strategies have shown varying statistical efficacy in terms of reducing the incidence of new onset mental health disorders. A systematic review on the impact of ICU diaries reported that four of five randomized trials showed a significantly reduced rate of new onset PTSD after 3 months with the use of ICU diaries. In addition, a meta-analysis of studies on psychological interventions, such as counseling, found that these interventions can significantly reduce symptoms of anxiety and depression. Furthermore, one study found that follow-up consultations may reduce the symptoms of PTSD after ICU admission, although they did not significantly improve other factors such as quality of life, anxiety, or depression.
Conclusion: Patients that survive an ICU stay are at a significant risk for developing a mental illness following their discharge. While the aforementioned studies provide evidence for the efficacy of these approaches, further research is needed to determine the most effective strategies for preventing new-onset mental health diagnoses in patients after ICU stay, with the ultimate objective of establishing proper guidelines to better navigate this issue. By prioritizing mental health in the ICU setting and providing appropriate resources to address these conditions, we can improve outcomes for patients and support their overall well-being beyond the acute care setting.

Preventing New Onset Mental Health Diagnoses After ICU Stay: Current and Emerging Approaches

Background
Screen time is defined as time spent watching television, playing video games, or using electronic devices with a screen. Levels of screen time have increased in the pediatric population with some individuals consuming over 7 hours per day. In the literature, screen time has been shown to have effects on neuropsychiatric health and development, but there are limited comprehensive studies. The aim of this study was to determine the effects of screen time on mental health and neurodevelopment in the child and adolescent population in North America.

Methods
We conducted an umbrella review to assess the psychological effects of screen time on health outcomes in children and adolescents. We searched PubMed and Google Scholar for systematic reviews or meta-analyses published within the last 10 years. Studies were included in our initial search if they had the words “screen-time” with “meta-analysis” or “systematic review”. A total of 15 systematic reviews were found. These were narrowed down to 4 total systematic reviews that specifically addressed the child and adolescent population as well as outcomes regarding depression, anxiety, sleep disruption, language development, and academic development. Effect sizes were collected.

Results
Screen time in children and adolescents was found to have significant associations with several neuropsychiatric variables, including risk of depression (odds ratio 1.12, 95% confidence interval 1.03-1.22) and decreased sleep duration (2.283 [2.132-2.445]). Additionally, the meta-analyses studied show a negative association between screen time and language skills (n = 38, r = -0.14 [−0.18 to −0.10], OR 0.599 [0.515-0.694]), and no association with academic performance (d = -0.29 [−0.65 to 0.08], OR 0.591 [0.308-1.156]). 

Conclusion
There is an association between increased screen time and some adverse neuropsychiatric outcomes, including risk of depression, decreased sleep duration, anxiety, and lower language skills. Furthermore, the literature has even demonstrated a dose-response relationship for some outcomes. For example, participants with high screen time were more likely to have depression than their low screen time counterparts. These findings are increasingly important as technology becomes more prevalent and suggest that recommendations to limit screen time may mitigate adverse neuropsychiatric outcomes. Limitations of this umbrella review include the cross-sectional design of the meta-analyses and the accuracy of screen time reporting.


The Association of Screentime With Neuropsychiatric Health in the Pediatric Population: An Umbrella Review


Introduction: Readmission within the first 90 days following total joint arthroplasty (TJA) is both a predictor of postoperative complications as well as a cause of increased financial burden. Patients living in socioeconomically disadvantaged areas are known to be at increased risk for worse healthcare outcomes. This study hypothesized that 90- day readmission rates following aseptic TJA were associated with Area Deprivation Index (ADI), a surrogate marker for patients living in economically disadvantaged neighborhoods. 

Methods: All primary and aseptic revision TJAs performed in 2019 at one academic center were reviewed. A total of 1,084 patients were included with home addresses in 11 different states. The Neighborhood Atlas was used to calculate both the national (0-100 scale) and state (0-10 scale) ADIs for all patients, using metrics that include income, education, employment and housing quality. Chi-square tests were used for statistical analysis to calculate logistic regression models and odds ratios (OR) for examining the relationship between state and national ADIs and hospital readmission within the first 90 days following TJA. 

Results: There were a total of 82 readmissions found in the patient cohort. Of these readmissions, 27 were due to infection. The average state ADI was 4.75 and the average national ADI was 65.30. Logistic regression models showed no significant trends in 90-day readmissions based on state ADI (P=0.29). There was a statistically significant positive correlation between national ADI and 90-day readmission rates (Unit OR 1.01, P< 0.05). 

Conclusions: This study demonstrated that as a patient’s national ADI increased, there was a positive association with a patient’s odds of readmission within 90 days of an aseptic TJA. State ADIs did not have a significant association with 90- day readmission rates. Further investigations are required to understand the impact of patients’ socioeconomic status on post-operative complications and causes for readmission.


Area Deprivation Index as a Predictor of 90-day Readmission Rates in Total Joint Arthroplasty


Background
The presence of wounds, from either acute or chronic circumstances, places a significant burden on a patient’s quality of life (QoL). In the US, as the number of patients with chronic health conditions such as diabetes mellitus, vascular disease, and obesity continues to rise, so does the risk of complications of wounds. Some of these complications include the increased risk of infection and further issues with tissue revascularization, both of which are associated with worse morbidity. The increasing patient population signifies the necessity for proper community education on wound care in the home and after in-office procedures to reduce the risk of further complications. Our study gathered community knowledge from a student-run free-dermatology clinic, according to AAD guidelines, to better assess community knowledge of wound care.

Methods
Using a 6-question paper survey with five multiple-choice questions and one 5-point Likert scale rating for confidence assessment of wound care knowledge (1 equating not confident and 5 equating very confident) was voluntarily answered by patients aged 18 years and older at a Free Student-Faculty Collaborative Dermatology Clinic. A quantitative analysis was run to interpret the 30 results. A one-tailed T-test was used to evaluate the responses to the multiple-choice questions under the assumption that getting three out of four questions indicated sufficient knowledge. 

Results
Although the average confidence from the responses was 4.33 using a Likert scale rating, further inquiry showed only 7.4% were using a method consistent with current AAD guidelines. Our results showed 51.85% of respondents were able to identify all the characteristics of an infected wound and 66.7% correctly chose the use of mild soap and water for washing. Only 23.1% of responses correctly identified that wounds need to be kept moist. Analyzing the multiple-choice questions, only 37.03% demonstrated sufficient knowledge of wound care (p<0.0005).

Conclusion
Our study demonstrated the importance of providing patients with standardized wound care education. Presently at our clinic, a wound care recommendation sheet in accordance with AAD recommendations is offered to patients who recieve biopsies or in-office procedures. The initiative was implemented to help close the education gap for patients regarding wound care. Clinics and providers can similarly provide materials or have posters in the office to highlight similar wound care recommendations. A limitation of this study was the small sample size and possible misinterpretation of the questions based on individual comprehension. 


Underline digital video library

LIVE - Explaining the decline of preferential matrilateral cross-cousin (impal) marriage among the Karo of Indonesia: An epidemiological approach to cultural evolution

Semantic Similarity Models for Depression Severity Estimation | VIDEO

Dolphin: A Challenging and Diverse Benchmark for Arabic NLG

Koala: An Index for Quantifying Overlaps with Pre-training Corpora

When Constipation is More than Just Constipation: A Rare Case of OHVIRA Syndrome

Addressing Diabetes and Food Insecurity: Community Health Workers and Clinic Based Food Referral Programs

Assessing Medical Students' Understanding of Fertility and Infertility: Implications for Physician Well-being and Reproductive Health

Automated and Optimized Neurosurgery Scheduling System Improves Resident Satisfaction

Preventing New Onset Mental Health Diagnoses After ICU Stay: Current and Emerging Approaches

The Association of Screentime With Neuropsychiatric Health in the Pediatric Population: An Umbrella Review

Area Deprivation Index as a Predictor of 90-day Readmission Rates in Total Joint Arthroplasty

Wound Care Knowledge in the Community Setting: Closing the Patient Education Gap

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