bluuebunny/crossref_metadata_2025 huggingface dataset:
A new LHe-free cryostat for the heterodyne SIS receiver for the Leighton Chajnantor Telescope
Authors: Li Yao , Cao Duo , Zhang Yi , He Xiaoyong , Liu Feng , Shi Wangzhou , Shu Chenggang
Published: July 2024

The Leighton Chajnantor Telescope (LCT) is an international collaborative program among Caltech, Shanghai Normal University (ShNU), and Universidad de Concepción (UdeC), aiming at the refurbishment and relocation of the Caltech Submillimeter Observatory (CSO) telescope from Mauna Kea, Hawaii, to the Chajnantor Plateau, northern Chile. A suite of excellent-sensitivity heterodyne superconductor–insulator–superconductor (SIS) receivers will be deployed to the telescope as the first set of instrumentations for high-resolution spectral observation. However, the current refrigeration technology for this receiver utilizes liquid helium (LHe), which greatly increases the cost of cooling and labor. To address this problem, a new LHe-free cryostat for the LCT heterodyne SIS receiver has been designed, fabricated, and tested. Mechanical and thermal analyses were performed to ensure that the cryostat meets the requirements of the telescope pointing accuracy and the SIS junction working environment, respectively. The experiment testing results are in good agreement with the calculation and analysis, indicating that the proposed LHe-free cryostat meets the operational requirements of the telescope at the new site.
COVID-19: from immune response to clinical intervention
Authors: Guo Zheng-yang , Tang Yan-qing , Zhang Zi-bo , Liu Juan , Zhuang Yu-xin , Li Ting
Published: July 2024

The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has highlighted the pivotal role of the immune response in determining the progression and severity of viral infections. In this paper, we review the most recent studies on the complicated dynamics between SARS-CoV-2 and the host immune system, highlight the importance of understanding these dynamics in developing effective treatments and formulate potent management strategies for COVID-19. We describe the activation of the host's innate immunity and the subsequent adaptive immune response following infection with SARS-CoV-2. In addition, the review emphasizes the immune evasion strategies of the SARS-CoV-2, including inhibition of interferon production and induction of cytokine storms, along with the resulting clinical outcomes. Finally, we assess the efficacy of current treatment strategies, including antiviral drugs, monoclonal antibodies, and anti-inflammatory treatments, and discuss their role in providing immunity and preventing severe disease.
Holistic Care for People Living With Chronic Musculoskeletal Pain: The Relevance and Importance of Sexual Function
Authors: Ackerman Ilana N , Restoux Laura , Dobo Brooke , Slater Helen , Ross Megan H , Briggs Andrew M
Published: July 2024

People living with chronic primary or secondary musculoskeletal pain conditions such as low back pain, fibromyalgia, and inflammatory arthritis typically experience wide-ranging impacts on their physical function, activity participation, and psychosocial wellbeing. These can extend to negative impacts on a person’s sexual function and their intimate relationships. While sexual function is an important component of wellbeing, it is often not considered within musculoskeletal pain care. Without awareness or targeted training, physical therapists may lack the confidence and skills to screen, assess, and manage the impacts that pain may be having on a person’s sexual function and can miss the opportunity to tailor their care and optimize wellbeing. This article seeks to raise awareness among physical therapists of how living with chronic musculoskeletal pain can impact a person’s sexual function and intimate relationships, and provide guidance on how to consider these issues within a person-centered approach to care. It describes why considering sexual function and intimate relationship issues as part of a person’s lived musculoskeletal pain experience may be relevant, outlines the use of validated patient-reported outcome measures to assess sexual dysfunction, and suggests practical strategies for sensitively raising sexual function in consultations. Management approaches and possible referral pathways are also presented, to assist physical therapists in understanding available care options. This article seeks to support holistic care by improving physical therapists’ knowledge and understanding of sexual dysfunction and its management in people living with chronic musculoskeletal pain.

Impact

Considering sexual function as a valued functional activity, together with other activities of daily living, will assist physical therapists to provide more holistic and person-centered care. This article covers the main considerations for raising sexual function and intimate relationship issues with people living with chronic musculoskeletal pain, as well as management options and potential referral pathways. Physical therapists are encouraged to seek targeted training to improve their confidence and skills in this area, and to use inclusive, respectful language for discussions around sexual function and intimate relationships.
Biodegradable microspheres via orally deliver celastrol with ameliorated neuropathic pain in diabetes rats
Authors: Zhao Haosen , Chen Shurui , Lin Sen , Mei Xifan
Published: July 2024

The treatment of peripheral neuropathy resulting from diabetes primarily emphasizes neurotrophic medications. However, a growing body of clinical studies indicates that neuroinflammation plays a significant role in the pathogenesis of neuropathic pain. This has spurred active exploration of treatment strategies leveraging nanomedicine for diseases, aiming for superior therapeutic outcomes. In this context, we have developed biodegradable nanoparticles made of polylactic-co-glycolic acid, loaded with triptolide (pCel), designed to alleviate somatic cell neuropathic pain induced by diabetes. Treatment with pCel notably reduced levels of reactive oxygen species and apoptosis in vitro. Furthermore, the progression of streptozotocin-induced diabetes, characterized by elevated renal function indices (blood urea nitrogen, creatinine), liver function indices (bilirubin, alkaline phosphatase) and decreased levels of albumin and globulin, was mitigated following pCel administration. Importantly, oral treatment with pCel significantly inhibited mechanical allodynia and the activation of the sciatic glial cells in diabetic rats. These findings indicate that this synthetic, biodegradable nanomedicine exhibits excellent stability, biocompatibility and catalytic activity, making it a promising and innovative approach for the management of chronic pain conditions associated with diabetic neuropathy.
Do functionality, strength, vascularization, inflammatory and biopsychosocial status improve by biopsychosocial model-based exercise in SSc?
Authors: Tüfekçi Orkun , Ünal Edibe , Aktaş Batuhan E , Tan Aziz A , Hartuç Çevik İrem , Karabulut Erdem , Pınar Aslı , Korkusuz Feza , Onur Mehmet R , Kiraz Sedat , Akdoğan Ali
Published: July 2024

Objectives

This study aimed to investigation of the effects of the Cognitive Exercise Therapy Approach [Bilişsel Egzersiz Terapi Yaklaşımı (BETY)], a supervised biopsychosocial model-based exercise intervention, on functionality, muscle strength, vascularization, anti-inflammatory and biopsychosocial status in SSc patients.

Methods

Thirty-seven SSc patients were included. Twenty of them were recruited into the study group (SG) undergoing BETY group exercise sessions three times a week for 3 months and seventeen were in the control group (CG) following a home exercise program. Assessment tools were the Modified Rodnan Skin Score (mRSS), Scleroderma HAQ (SHAQ), Modified Hand Mobility in Scleroderma (mHAMIS), Duruoz Hand Index (DHI), Six-Min Walk Test (6-MWT), skeletal muscle strength measurements using an isokinetic dynamometer (Biodex System 3 Pro), Shear Wave Elastography, ELISA kits (for tumour necrosis factor-alpha, Interleukin-6, IL-10, serum irisin level), BETY-Biopsychosocial Questionnaire (BETY-BQ), Hospital Anxiety and Depression Scale (HADS) and Short Form-36 (SF-36).

Results

The SG demonstrated improvements in SHAQ, mHAMIS, 6-MWT, BETY-BQ, HADS and SF-36 values, excluding the DHI scores (P < 0.05). In contrast, CG showed worsening in SHAQ-general scleroderma symptoms and HADS scores compared with SG (P < 0.05). IL-10 and TNF-alpha increased in both groups, also various vascular parameters were significantly different changed in SG than CG (P < 0.05). Muscle strength values improved in the SG but decreased in the CG, however, this was statistically not significant (P > 0.05).

Conclusion

BETY can be recommended as a non-pharmacological approach to the disease management of SSc patients.
The logic of patronage: relational work in Cambodian international nongovernmental organizations
Authors: Wilks Mary-Collier
Published: July 2024

How do managers in transnational workplaces adapt financial logics from the Global North to patronage systems in the Global South? This article answers this question through a comparative ethnographic study of two international nongovernmental organizations (INGOs) working in Cambodia, one with funding from Japan and the other supported by the USA. Drawing on theories of institutional logics and the sociology of economic exchange, I document how managers localize the logics of foreign aid donors to meet worker expectations around budgeting and compensation in the two INGO workplaces. I illustrate that INGOs are more likely to succeed in the localization process when aid logic enables cooperation between foreign and local managers. My findings suggest that studies of foreign aid could benefit from investigating the consequences of national variation on aid donors’ financial practices. Additionally, scholarship on transnational workplaces needs to take seriously the logic of patronage and the role of relational work in adapting this logic in workplaces in the Global South.
Professional and Personal Attitudes toward Discussing Sexuality and Degree of Religiosity among Social Workers
Authors: Ali-Saleh Darawshy Neveen , Timor-Shlevin Shachar , Lavie-Ajayi Maya
Published: July 2024

This study investigated the correlations between social workers’ levels of religiosity and their professional attitudes toward discussing sexual health. The focus was particularly on the potential mediating role of their attitudes to heteronormative beliefs. A random sample of 150 social workers from Israel (Jewish [63.3 percent], Palestinian-Arab [36 percent], and those who self-identified as “other” [0.7 percent]) completed a self-administered questionnaire. The findings revealed significant correlations among professional attitudes toward discussing sexual health, attitudes toward heteronormativity, and degree of religiosity. Social workers with higher levels of religiosity exhibited higher levels of heteronormative beliefs, which, in turn, influenced their professional attitudes toward discussing sexual health. Furthermore, the findings highlight the importance of challenging heteronormative perspectives for all social welfare service users. Social work must establish culturally sensitive training to challenge the hegemony of heteronormative perspectives while connecting to religious and conservative values and perceptions.
Application of the IASP Grading System to Identify Underlying Pain Mechanisms in Patients With Knee Osteoarthritis
Authors: Vervullens Sophie , Meert Lotte , Meeus Mira , Heusdens Christiaan H.W. , Verdonk Peter , Foubert Anthe , Abatih Emmanuel , Durnez Lies , Verbrugghe Jonas , Smeets Rob J.E.M.
Published: July 2024

Objectives:

This study aimed to apply the International Association for the Study of Pain (IASP) grading system for identifying nociplastic pain in knee osteoarthritis (KOA) awaiting total knee arthroplasty (TKA) and propose criteria to fine-tune decision-making. In addition, the study aimed to characterize a “probable” versus “no or possible” nociplastic pain mechanism using biopsychosocial variables and compare both groups in their 1-year post-TKA response.

Methods:

A secondary analysis of baseline data of a longitudinal prospective study involving 197 patients with KOA awaiting total TKA in Belgium and the Netherlands was performed. Two approaches, one considering 4 and the other 3 pain locations (step 2 of the grading system), were presented. Linear mixed model analyses were performed to compare the probable and no or possible nociplastic pain mechanism groups for several preoperative biopsychosocial-related variables and 1-year postoperative pain. Also, a sensitivity analysis, comparing 3 pain mechanism groups, was performed.

Results:

Thirty (15.22%—approach 4 pain locations) and 46 (23.35%–approach 3 pain locations) participants were categorized under probable nociplastic pain. Irrespective of the pain location approach or sensitivity analysis, the probable nociplastic pain group included more woman, was younger, exhibited worse results on various preoperative pain-related and psychological variables, and had more pain 1-year post-TKA compared with the other group.

Discussion:

This study proposed additional criteria to fine-tune the grading system for nociplastic pain (except for discrete/regional/multifocal/widespread pain) and characterized a subgroup of patients with KOA with probable nociplastic pain. Future research is warranted for further validation.
Clinical Presentation and Outcomes of Diabetic Ketoacidosis in Pregnancy
Authors: Grasch Jennifer L. , Lammers Sydney , Scaglia Drusini Florencia , Vickery Selina S. , Venkatesh Kartik K. , Thung Stephen , McKiever Monique E. , Landon Mark B. , Gabbe Steven
Published: July 2024

OBJECTIVE:

To examine the presentation, management, and outcomes of pregnancies complicated by diabetic ketoacidosis (DKA) in a contemporary obstetric population.

METHODS:

This is a case series of all admissions for DKA during pregnancy at a single Midwestern academic medical center over a 10-year period. Diabetic ketoacidosis was defined per the following diagnostic criteria: anion gap more than 12 mEq/L, pH less than 7.30 or bicarbonate less than 15 mEq/L, and elevated serum or urine ketones. Demographic information, clinical characteristics, and maternal and neonatal outcomes were assessed. Patient characteristics and clinical outcomes were compared between individuals with type 1 and those with type 2 diabetes mellitus.

RESULTS:

Between 2012 and 2021, there were 129 admissions for DKA in 103 pregnancies in 97 individuals. Most individuals (n=75, 77.3%) admitted for DKA during pregnancy had type 1 diabetes. The majority of admissions occurred in the third trimester (median gestational age 29 3/7 weeks). The most common precipitating factors were vomiting or gastrointestinal illness (38.0%), infection (25.6%), and insulin nonadherence (20.9%). Median glucose on admission was 252 mg/dL (interquartile range 181–343 mg/dL), and 21 patients (17.6%) were admitted with euglycemic DKA. Fifteen admissions (11.6%) were to the intensive care unit. Pregnancy loss was diagnosed during admission in six individuals (6.3%, 95% CI, 2.3–13.7%). Among pregnant individuals with at least one admission for DKA, the median gestational age at delivery was 34 6/7 weeks (interquartile range 33 2/7–36 3/7 weeks). Most neonates (85.7%, 95% CI, 76.8–92.2%) were admitted to the neonatal intensive care unit and required treatment for hypoglycemia. The cesarean delivery rate was 71.9%. Despite similar hemoglobin A1C values before pregnancy and at admission, individuals with type 1 diabetes had higher serum glucose (median [interquartile range], 256 mg/dL [181–353 mg/dL] vs 216 mg/dL [136–258 mg/dL], P=.04) and higher serum ketones (3.78 mg/dL [2.13–5.50 mg/dL] vs 2.56 mg/dL [0.81–4.69 mg/dL] mg/dL, P=.03) on admission compared with those with type 2 diabetes. Individuals with type 2 diabetes required intravenous insulin therapy for a longer duration (55 hours [29.5–91.5 hours] vs 27 hours [19–38 hours], P=.004) and were hospitalized longer (5 days [4–9 days] vs 4 days [3–6 days], P=.004).

CONCLUSION:

Diabetic ketoacidosis occurred predominantly in pregnancies affected by type 1 diabetes. Individuals with type 1 diabetes presented with greater DKA severity but achieved clinical resolution more rapidly than those with type 2 diabetes. These results may provide a starting point for the development of interventions to decrease maternal and neonatal morbidity related to DKA in the modern obstetric population.
Continuous Glucose Monitoring for Diabetes Management During Pregnancy
Authors: Battarbee Ashley N. , Durnwald Celeste , Yee Lynn M. , Valent Amy M.
Published: July 2024

Continuous glucose monitoring (CGM) has the potential to revolutionize diabetes management during pregnancy by providing detailed and real-time data to patients and clinicians, overcoming many of the limitations of self-monitoring of blood glucose. Although there are limited data on the role of CGM to improve pregnancy outcomes in patients with type 2 diabetes or gestational diabetes, CGM has been shown to reduce pregnancy complications in patients with type 1 diabetes. Despite the limited data in some populations, given its ease of use and recent U.S. Food and Drug Administration approval with expanding insurance coverage, CGM has gained widespread popularity among pregnant patients with all types of diabetes. It is critical for obstetric clinicians to understand how CGM can be successfully integrated into clinical practice. We present a practical, step-wise approach to CGM data interpretation that can be incorporated into diabetes management during pregnancy and common CGM pitfalls and solutions. Although technology will continue to advance with newer-generation CGM devices and diabetes technology such as automated insulin delivery (not covered here), these key principles form a basic foundation for understanding CGM technology and its utility for pregnant people.
Visual Mapping of Operating Theater Team Dynamics and Communication for Reflexive Feedback and Surgical Practice Optimization
Authors: Surendran Surya , Bonaconsa Candice , Nampoothiri Vrinda , Mbamalu Oluchi , George Anu , Mallick Swetha , OV Sudheer , Holmes Alison , Mendelson Marc , Singh Sanjeev , Birgand Gabriel , Charani Esmita
Published: July 2024

Background:

Effective operating theater (OT) communication and teamwork are essential to optimal surgical outcomes. We mapped the OT team dynamics and infection control practices using visual methods to guide reflexive feedback and optimize perioperative practices.

Methods:

Data were gathered from adult gastrointestinal surgical teams at a tertiary hospital in India using observations, sociograms (communication mapping tool), and focus group discussions (FGDs). Our methods aimed to map team communication, roles and responsibilities in infection-related practices, and door openings. Qualitative data were thematically analyzed. Quantitative data were analyzed using descriptive statistics.

Results:

Data were gathered from 10 surgical procedures (over 51 hours) using 16 sociograms, 15 traffic flow maps, and 3 FGDs. Senior surgeons directly influence team hierarchies, dynamics, and communication. While the surgeons, anesthetic residents, and technicians lead most tasks during procedures, the scrub nurse acts as a mediator coordinating activity among role players across hierarchies. Failing to provide the scrub nurse with complete details of the planned surgery leads to multiple door openings to fetch equipment and disposables. Traffic flow observed in 15-minute intervals corresponds to a mean frequency of 56 door openings per hour (min: 16; max: 108), with implications for infection control. Implementing the World Health Organization surgical safety checklist was inconsistent across pathways and does not match reported compliance data.

Conclusions:

Human factors research is important in optimizing surgical teamwork. Using visual methods to provide feedback to perioperative teams on their communication patterns and behaviors, provided an opportunity for contextualized enhancement of infection prevention and control practices.
Improving Wound Healing and Infection Control in Long-term Care with Bacterial Fluorescence Imaging
Authors: Kelso Martha R. , Jaros Mark
Published: July 2024

BACKGROUND

High bacterial burden stalls wound healing and can quickly progress to infection and sepsis in complex, older-adult patients in long-term care (LTC) or skilled nursing facilities (SNFs).

OBJECTIVE

To investigate the outcomes of point-of-care fluorescence (FL) imaging (MolecuLight i:X) of bacterial loads, which are frequently asymptomatic, to inform customized wound treatment plans for patients in LTC/SNFs.

METHODS

In this retrospective pre/postinterventional cohort study, the authors compared the healing and infection-associated outcomes of 167 pressure injuries from 100 Medicare beneficiaries before and after implementation of FL imaging.

RESULTS

Most patient demographics and wound characteristics did not differ significantly between the standard-of-care (SOC; n = 71 wounds) and FL (n = 96 wounds) cohorts. Significantly more wounds (+71.0%) healed by 12 weeks in the FL cohort (38.5%) versus the SoC cohort (22.5%). Wounds in the FL cohort also healed 27.7% faster (−4.8 weeks), on average, and were 1.4 times more likely to heal per Kaplan-Meier survival analysis (hazard ratio = 1.40; 95% CI, 0.90-2.12). Infection-related complications decreased by 75.3% in the FL cohort, and a significant shift from largely systemic to topical antibiotic prescribing was evidenced.

CONCLUSIONS

Fluorescence-imaging-guided management of wounds significantly improved healing and infection outcomes in highly complex and multimorbid patients in LTC/SNFs. Proactive bacterial infection management via local treatments was enabled by earlier, objective detection. These reported outcome improvements are comparable to randomized controlled trials and cohort studies from less compromised, selectively controlled outpatient populations. Fluorescence imaging supports proactive monitoring and management of planktonic and biofilm-encased bacteria, improving patient care in a complex, real-world setting.
Enoxaparin and Early Postoperative Tibial Nailing: Increased Nonunion Revision Rates
Authors: Lindsay Sarah E. , Working Zachary M. , Friess Darin , Smith Spencer , Yoo Jung
Published: July 2024

OBJECTIVES:

To determine the association between postoperative enoxaparin use and the risk of requiring surgery for nonunion in patients treated with intramedullary nailing for midshaft fractures of the tibia.

METHODS:

Design:

Retrospective cohort analysis.

Setting:

Data were sourced from the PearlDiver national database.

Patient Selection Criteria:

Patients were identified through the PearlDiver database by using Current Procedural Terminology and International Classification of Diseases (ICD-10) codes. Included patients had undergone intramedullary nailing for midshaft fractures of the tibia between 2015 and 2020 and subsequently underwent revision surgery due to nonunion.

Outcome Measures and Comparisons:

The primary outcome measured in this study was the rate of nonunion following intramedullary nailing for the different types of tibial shaft fractures (closed, Type I/II open, Type III open). For each fracture subtype, the study compared nonunion rates between those who received enoxaparin in the postoperative period and those who did not receive enoxaparin at any time during the first 6 weeks postoperatively. Factors such as the timing and duration of enoxaparin therapy and demographic variables were also considered.

RESULTS:

The study included 16,986 patients, average age was 49.2 years (SD 17.3); 43.1% were female. Five hundred four patients required revision surgery for nonunion (3.4%). Among patients who did not receive enoxaparin, the nonunion rates were 1.6%, 3.9%, and 6.9% for closed, Type I/II open, and Type III open fractures, respectively. For patients who received enoxaparin within the first 2 weeks, the nonunion rates were 2.6%, 4.7%, and 7.9% for closed (RR = 1.67, P < 0.0001), Type I/II open (RR = 1.21, P < 0.0001), and Type III open (RR = 1.17, P = 0.355) fractures, respectively. Logistic regression confirmed enoxaparin was independently associated with nonunion (odds ratios [OR] = 1.75, P = 0.0013 for closed fractures; OR = 1.51, P = 0.034 for Type I/II open fractures). Tobacco use was also a contributing factor (OR = 2.43, P < 0.0001 for closed fractures; OR = 2.00, P < 0.0001 for Type I/II open fractures; OR = 2.04, P = 0.0008 for Type III open fractures).

CONCLUSIONS:

The postoperative use of enoxaparin was associated with an elevated risk of nonunion in patients treated with intramedullary nailing for fractures of the tibial shaft.

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Targeting xCT with sulfasalazine suppresses triple-negative breast cancer growth via inducing autophagy and coordinating cell cycle and proliferation
Authors: Long Yaping , Xu Zizheng , Yu Jing , Hu Xiao , Xie Yu , Duan Xianxian , Li Ning , Yan Yan , Wang Yue , Qin Junfang
Published: July 2024

There is a substantial unmet need for effective treatment strategies in triple-negative breast cancer (TNBC). Recently, renewed attention has been directed towards targeting glutamine (Gln) metabolism to enhance the efficacy of cancer treatment. Nonetheless, a comprehensive exploration into the mechanistic implications of targeting Gln metabolism in TNBC is lacking. In this study, our objective was to probe the sensitivity of TNBC to alterations in Gln metabolism, using representative TNBC cell lines: MDA-MB-231, MDA-MB-468, and 4T1. Through an integration of bioinformatics, in-vitro, and in-vivo investigations, we demonstrated that sulfasalazine (SAS), like erastin (a known xCT inhibitor), effectively suppressed the expression and transport function of xCT, resulting in a depletion of glutathione levels in MDA-MB-231 and MDA-MB-468 cells. Furthermore, both xCT knockdown and SAS treatment demonstrated the promotion of cellular autophagy. We unveiled a positive correlation between xCT and the autophagy-related molecule p62, their co-expression indicating poor survival outcomes in breast cancer patients. In addition, our research revealed the influence of SAS and xCT on the expression of proteins regulating cell cycle and proliferation. Treatment with SAS or xCT knockdown led to the inhibition of MYC, CDK1, and CD44 expression. Significantly, the combined administration of SAS and rapamycin exhibited a synergistic inhibitory effect on the growth of transplanted breast tumor in mouse models constructed from murine-derived 4T1 cells. Taken together, our findings suggested the potential and clinical relevance of the SAS and rapamycin combination in the treatment of TNBC.
Stanford Network for Advancement and Promotion: The impact of a community building-focused leadership development program on the success of underrepresented groups in academic medicine
Authors: Fassiotto Magali , Jerome Barbara , Stefanac Lisa , Oaiya Osagie , Quihuis Gisell , Maldonado Yvonne , Harris Odette
Published: July 2024

Background

Leadership can be an isolating experience and leaders from underrepresented groups (URGs) may experience even greater isolation and vulnerability because of lack of representation. Given the collaborative nature of medicine, leadership programs for physicians need to address isolation. Social support is one mechanism to combat this isolation; however, most leadership programs focus exclusively on skills building.

Purpose

The Stanford Network for Advancement and Promotion (SNAP) program was developed to reduce isolation among physician leaders from URGs in academic medicine leadership by building a supportive network of peers.

Methodology/Approach

Ten women physicians from diverse racial/ethnic backgrounds were invited to participate in SNAP. Annual surveys were administered to participants to assess the effectiveness of SNAP on decreasing feelings of isolation and increasing professional leadership growth. The authors charted the expansion and adaptation of the program model across gender and in additional settings.

Results

SNAP effectively created a sense of community among the physician leaders. Participants also reported feeling challenged by the program and that they had grown in terms of critical thinking, organizational knowledge, and empowerment as leaders. Participants found community building to be the most valuable program component. Because of this success, the SNAP model has been adapted to create 10 additional cohorts.

Conclusion

Leadership programs like SNAP that focus on reducing isolation are instrumental for retaining and promoting the career advancement of physicians from URGs.

Practice Implications

Developing a diverse workforce of academic physicians is essential to providing high-quality and equitable clinical care, research, and medical education.
Selective Laser Trabeculoplasty Versus Medical Therapy for the Treatment of Open Angle Glaucoma or Ocular Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Chavez Matheus Pedrotti , Guedes Guilherme Barroso , Pasqualotto Eric , Lopes Lucca Moreira , Ferreira Rafael Oliva Morgado , de Souza Eduardo Soares Maia Vieira , de Souza Tiago Tomaz
Published: July 2024

Précis:

Selective laser trabeculoplasty (SLT) and medical therapy groups displayed comparable intraocular pressure (IOP) at most follow-ups. SLT was associated with significantly decreased rates of glaucoma surgeries, antiglaucomatous medications, and ocular adverse effects.

Purpose:

To evaluate the efficacy and safety of SLT compared with medical therapy in the treatment of open angle glaucoma (OAG) or ocular hypertension (OHT).

Methods:

A systematic search was performed in PubMed, Embase, Cochrane Library and Web of Science databases. Randomized controlled trials (RCTs) comparing SLT with medical therapy were included. We computed mean differences (MDs) or standardized mean differences (STDs) for continuous endpoints and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed with I
2 statistics. Software R, version 4.2.1, was used for statistical analyses. Subgroup analyses were performed on treatment-naive patients and on the class of drugs in the medical therapy group.

Results:

Fourteen RCTs comprising 1706 patients were included, of whom 936 were submitted to SLT. Medical therapy was associated with a significantly improved IOP at 1 month and a higher proportion of patients achieving ≥20% IOP reduction. There were no significant differences between groups in IOP at 2, 3, 6, and 12 months, IOP fluctuation, rate of eyes at target IOP, visual field, and quality of life. The SLT group exhibited significantly decreased rates of glaucoma surgeries, antiglaucoma medications, and ocular adverse effects.

Conclusions:

SLT demonstrated comparable efficacy to medical therapy in IOP control at most follow-ups, along with favorable impacts on critical treatment-related factors. Our findings support SLT as a safe and effective treatment for OAG or OHT.
Prevalence and Predictors of Tuberculosis Infection in Children and Adolescents in Rural Uganda: A Cross-sectional Study
Authors: Kakande Elijah , Ssekyanzi Bob , Abbott Rachel , Ariho Willington , Nattabi Gloria , Landsiedel Kirsten , Temple Jennifer , Chamie Gabriel , Havlir Diane V. , Kamya Moses R. , Charlebois Edwin D. , Balzer Laura B. , Marquez Carina
Published: July 2024

Background:

Much of the latent tuberculosis (TB) reservoir is established in childhood and adolescence. Yet, age-specific data on prevalence and predictors of infection in this population are sparse and needed to guide prevention and case finding.

Methods:

From December 2021 to June 2023, we measured TB infection in children 1–17 years in 25 villages in rural Southwestern Uganda. We defined TB infection as a positive QuantiFERON Gold Plus Test (QFT). We estimated overall and age-stratified population-level prevalence and adjusted risk ratios (aRR) of TB infection for individual, household, and community-based predictors, accounting for age, TB contact, and clustering by household.

Results:

Estimated TB infection prevalence was 9.6% [95% confidence interval (CI): 8.7–10.5%] among the 5789 participants, and prevalence varied slightly with age. Household-level risk factors included crowding (aRR: 1.25, 95% CI: 1.03–1.53), indoor cooking (aRR: 1.62, 95% CI: 1.14–2.30), living with ≥2 persons who drink alcohol (aRR: 1.47, 95% CI: 1.04–2.07). The predominant community-based risk factor was child mobility (aRR: 1.67, 95% CI: 1.24–2.26). In age-stratified analyses, household predictors were important in early childhood but not adolescence, where mobility was predominant (aRR: 1.66, 95% CI: 1.13–2.44).

Conclusion:

We detected a high prevalence of TB infection in children and adolescents in rural Uganda. On a population level, TB risk factors change throughout the early life course, with child mobility a key risk factor in adolescence. Age-specific TB case finding and prevention strategies that address both household and extra-household risk factors are needed to address TB transmission.
Postoperative prognostic nutrition index predicts survival in patients with small bowel adenocarcinoma after surgical resection
Authors: Li Chia-Ju , Lee Pei-Chang , Huang Kuo-Wei , Huang Kuan-Jung , Chang Tien-En , Chang Ching-Chih , Wang Shin-E. , Shyr Yi-Ming , Li Chung-Pin , Luo Jiing-Chyuang , Hou Ming-Chih
Published: July 2024

Background:

Surgical resection (SR) is the main treatment for small bowel adenocarcinoma (SBA), but it increases metabolic demand, systemic inflammation, and digestive dysfunction, resulting in major impacts on the postoperative outcomes of patients. In this study, we aimed to investigate the role of the postoperative prognostic nutritional index (PNI), a surrogate marker of inflammation and nutrition, in patients with SBA after resection.

Methods:

From June 2014 to March 2022, 44 consecutive patients who underwent SR for SBA in Taipei Veterans General Hospital were retrospectively reviewed. Factors associated with survival including PNI were analyzed.

Results:

PNI decreased in patients after SR for SBA (median change: −1.82), particularly in those who underwent Whipple operation or developed postoperative pancreatic fistula. Postoperative PNI <45.2 best predicted overall survival (OS) (area under the receiver operating characteristic curve [AUROC]: 0.826, p = 0.001). Patients with lower postoperative PNI had significantly worse OS compared to those with higher postoperative values (median OS: 19.3 months vs not reached, p < 0.001). Low postoperative PNI (hazard ratio [HR]: 11.404, p = 0.002), tumoral lymphovascular invasion (HR: 8.023, p = 0.012), and adjuvant chemotherapy (HR: 0.055, p = 0.002) were independent risk factors for OS. Postoperative PNI also significantly predicted recurrence-free survival independent of lymphovascular invasion and adjuvant chemotherapy (HR: 6.705, p = 0.001).

Conclusion:

PNI commonly decreases in patients with SBA who undergo Whipple surgery or develop postoperative pancreatic fistula. Postoperative PNI independently predicts survival and may serve as a clinical marker to optimize patient outcomes.
Chronic spontaneous urticaria: diagnosis, treatment, and management
Authors: Kogelman Jesse S.
Published: July 2024

Chronic spontaneous urticaria (CSU) is a disabling condition in which recurrent wheals, with or without angioedema, occur for over 6 weeks. CSU occurs in up to 1% of the general population at any time and, on average, lasts 2–5 years in duration. Standard therapy for CSU includes second-generation antihistamines and omalizumab. However, 25%–50% of patients are refractory to these treatments. CSU profoundly impairs patients’ quality of life and has a substantial societal impact, including significant health care costs and decreased work productivity. These factors underscore the importance of health care providers to be familiar with the diagnosis and management of this condition. This article reviews the epidemiology, pathogenesis, aggravating factors, clinical manifestations, diagnostic assessment, and treatment of CSU.
Prevalence, Bother, and Risk Factors Associated With Occurrence of Pelvic Floor Dysfunctions in Young Women: A Cross-Sectional Survey
Authors: Campos Natália Cardoso , de Carvalho Gabriela Martins , Santos Rafaela Aparecida de , Oliveira Rafael Dias de Brito , Sunemi Mariana Maia de Oliveira , Figueiredo Elyonara Mello
Published: July 2024

Purpose:

Pelvic floor dysfunctions (PFD) have been increasingly reported in young female athletes, but it is likely that young women, not specific to athletes, might also experience symptoms of PFD. This study investigated the occurrence of PFD symptoms in young women from the general population, their degree of bother and functional and clinical factors associated with these occurrences.

Methods:

Online survey was conducted with young women from the general population, not specific to athletes. Sociodemographic and clinical data, symptoms of urinary (UI) and anal incontinence (AI), pelvic organ prolapse, dyspareunia, chronic pelvic pain, and functional constipation, as well as their degree of bother were collected using validated questionnaires. Fisher exact and χ2 tests, Student t tests, and logistic regression models were applied (α = .05).

Results:

A total of 337 women aged 18 to 25 years were investigated. The overall occurrence of PFD was 60.0%. Dyspareunia was the most prevalent symptom (49.2%), followed by UI (44.2%) and constipation (21.7%). Higher degree of bother was reported for UI, AI, and chronic pelvic pain, respectively. Constipation (P < .001) and anxiety (P = .004) were associated with occurrence of PFD, increasing the chances of PFD by 4 and 2 times, respectively.

Discussion:

The high occurrence, co-occurrence, and bother of PFD in young women suggest impairments in pelvic floor muscle functions that should be investigated by physical therapists. Educational programs including preventive strategies and the role of physical therapists in the treatment of PFD should be provided from early ages.
Synergistic susceptibility to environmental lead toxicity in chronic kidney disease
Authors: Danziger John
Published: July 2024

Purpose of review

While high levels of lead exposure, as occurs accidentally or occupationally, can cause toxicity across multiple organ systems, the hazard of commonly encountered levels of lead in the environment remains unresolved. Challenges to researching the health effects of lead include its complex interplay with renal function, rendering analyses at risk of unaccounted confounding, and the likely small effect size of environmental levels of exposure. While children are known to be disproportionately susceptible to lead toxicity, resulting in appropriately more stringent regulatory surveillance for those under 5 years old, emerging evidence suggests that those with chronic kidney disease (CKD) similarly are at a greater risk. This review summarizes the role of environmental lead toxicity as a potential cause and consequence of CKD.

Recent findings

Whether environmental lead exposure causes CKD remains debatable, with little recent research advancing the conflicting, mostly cross-sectional, analyses from years ago. However, an emerging body of evidence suggests that CKD increases the susceptibility to lead toxicity. Higher circulating lead levels and lower urinary excretion result in greater lead accumulation in CKD, with simultaneous greater risk of clinically meaningful disease. Recent studies suggest that levels of lead found commonly in the United States drinking water supply, and currently permissible by the Environmental Protection Agency, associate with hematologic toxicity in those with advanced CKD. Whether environmental lead contamination may have additional negative health impact among this at-risk population, including cardiovascular and neurocognitive disease, warrants further study.

The underlying pathophysiology of kidney disease synergizes the susceptibility to environmental lead toxicity for those with CKD. Low levels of exposure, as found commonly in the United States water supply, may have adverse health impact in CKD. Further research will be needed to determine if more stringent environmental regulations are warranted to protect the health of all.
A case report of hemorrhagic shock from rare ruptured intertitial pregnancy
Authors: Teyib Roughaya , kassou Oumaima , Zeraidi Najia , Lakhdar Amina , Baidada Aziz
Published: July 2024

Introduction and importance:

Interstitial pregnancy is rare and exhibit a mortality rate notably higher than that observed in other types of ectopic pregnancies.

Case presentation:

The authors report a 38-year-old female admitted for a hemorrhagic shock. She was 10 weeks pregnant. The suspicion of a ruptured ectopic pregnancy arose based on amenorrhea accompanied by abdominal pain and a pelvic ultrasound showing an empty uterus and abundant free fluid in the abdomen. Emergent exploratory laparotomy was indicated by hemodynamic instability, revealing a ruptured left interstitial ectopic pregnancy.

Discussion:

The use of three-dimensional ultrasonographic imaging specially in the first trimester improves the rate for early detection. The medical or surgical management of an interstitial pregnancy depends on the patient’s hemodynamic stability considering the rupture of the pregnancy.

Conclusion:

Interstitial pregnancy is linked to elevated morbidity. Early diagnosis and adequate management both can avoid its catastrophic outcomes.
Clinical profile and complications seen in the patients in the later stages of chronic kidney disease presenting to the Emergency Department in a tertiary care center in Nepal: a cross-sectional study
Authors: Sharma Aditi , Bhusal Laxman , Rajbhandari Ajaya , Maharjan Swojay , Adhikari Abhishek , Aryal Egesh
Published: July 2024

Introduction:

Chronic kidney disease (CKD) has an estimated prevalence of 6% in Nepal, which has resulted in a huge public health and socioeconomic burden for the country. People with different stages of CKD come to the Emergency Department (ED) with various clinical features and complications, which if detected and managed early can result in a decreased need for renal replacement therapy and thus decreased medical cost.

Methods:

The authors conducted a cross-sectional analysis taking nonprobability convenience sampling in the ED of a tertiary-level hospital of Nepal, after getting approval from the Institutional Review Committee and obtaining informed consent from the patient. Kruskal–Wallis test and χ
2 test of homogeneity were conducted to determine if there were differences in the continuous variables and categorical variables of three stages of CKD. Pairwise comparisons with a Bonferroni correction was done for both variables.

Result:

Among 291 patients of CKD, 25 were in stage 3, 15 in stage 4, and 251 in stage 5. Significant differences between groups were found in continuous variables of SBP, pulse, temp, TLC, platelet, sodium, potassium, urea, and creatinine. Similarly, a significant difference was found for the categorical variables of hyperkalemia, hyponatremia, thrombocytopenia, leukocytosis, and high creatinine levels.

Conclusion:

Patients with CKD commonly present to the ED due to electrolyte imbalances, uremia, shortness of breath, and high SBP. Hyperkalemia, thrombocytopenia are more frequently observed in stage 5 CKD, whereas the incidence of hypertension significantly increase from stage 4 onwards. Hyponatremia, on the other hand, is more prevalent in stage 3 than in the later stages.
Palliative Care Needs of Women With Advanced Chronic Obstructive Pulmonary Disease
Authors: Madiraca Jessica , Lindell Kathleen , Phillips Shannon , Coyne Patrick , Miller Sarah
Published: July 2024

Individuals with chronic obstructive pulmonary disease (COPD) experience high symptom burden, severe illness, and frequent deterioration in quality of life. Women with COPD represent a unique population with potential unmet care needs yet remain underrepresented in palliative care (PC) literature. The purpose of this study was to investigate specific needs of women with COPD, learn how COPD symptoms impact women, and explore factors related to PC knowledge, access, and barriers. A total of 30 individuals were enrolled in this prospective, single-arm multimethod study, using an adapted Maslow's hierarchy of needs framework. Fifteen participated in semistructured interviews. Women with advanced COPD identified care needs and barriers including access to medications/oxygen and resources (pulmonary rehabilitation/support groups), information about disease/treatment, and effect of weather conditions on symptoms. Some participants were not under the direct care of a pulmonologist but recognized the importance of their services. None of the participants had been referred to or received PC. This study provides evidence that women have unmet care needs, high symptom burden, and disease uncertainty. Women with COPD should have the opportunity to have the supportive care that PC offers. Palliative care and hospice nurses have opportunities to address unmet care needs, increased symptom burden, and disease uncertainty.
Staffing Models
Authors: Stephenson Marshall , Jabur Tiago , Young Ginger , Patton Lindsey
Published: July 2024

Traditional staffing models rely on the productivity metric of hours per patient day, lacking the ability to adequately capture the nursing workload. Acuity-based staffing considers the patient population's acuity for appropriate nursing workload. Using process improvement methodology, a pediatric ICU transitioned to an acuity-based staffing model resulting in an 11.3% (P < 0.05) reduction in the acuity per nursing assignment and a decrease in reportable safety events by 61.3% (P < 0.05).
Assessment of Interobserver Agreement Among Gynecologic Pathologists Between Three-Tier Versus Binary Pattern-based Classification Systems for HPV-associated Endocervical Adenocarcinoma
Authors: Zyla Roman E. , Dodington David W. , Pakbaz Sara , Terzic Tatjana , Robinson Carrie , Clarke Blaise , Rouzbahman Marjan , Hodgson Anjelica
Published: July 2024

The three-tier (A vs. B vs. C) pattern-based (Silva) classification system is a strong and fairly reproducible predictor of the risk of lymph node involvement and recurrence of human papillomavirus (HPV)-associated endocervical adenocarcinoma (EA). Recently, a binary pattern-based classification system has been proposed which incorporates the Silva pattern and lymphovascular invasion (LVI) to assign tumors as “low risk” or “high risk” and this may have superior prognostic significance compared with the three-tier system as well as current International Federation of Gynecology and Obstetrics (FIGO) staging of cervix-confined disease. The interobserver reproducibility of this binary system, however, is unknown. Representative slides from 59 HPV-associated EAs (1-3 slides/case) were independently reviewed by 5 gynecologic pathologists who participated in an online training module before the study. In the first review, a pattern was assigned using the three-tier system. On the second review, a “low risk” or “high risk” designation was assigned and the presence or absence of LVI was specifically documented. Interobserver agreement was assessed using Fleiss’ kappa. The binary system showed improved interobserver agreement (kappa=0.634) compared with the three-tier system (kappa=0.564), with a higher proportion of cases having agreement between at least 4/5 reviewers (86% vs. 73%). Nineteen and 8 cases showed improved and worse interobserver agreement using the binary system, respectively; the remainder showed no change. 3/5 reviewers showed no intraobserver discrepancy while the remaining 2 did in a small subset of cases (n=2 and 4, respectively). In this study, a binary pattern-based classification system showed improved interobserver agreement compared with the traditional three-tier system.