Patient-reported outcomes in patients with relapsed or refractory follicular lymphoma treated with zanubrutinib plus obinutuzumab versus obinutuzumab monotherapy: results from the ROSEWOOD trial.

OBJECTIVE: We report patient-reported outcomes (PROs) measuring health-related quality of life (HRQoL) from the ROSEWOOD trial (NCT03332017), which demonstrated superior efficacy and a manageable safety profile with zanubrutinib plus obinutuzumab (ZO) versus obinutuzumab (O) in patients with heavily pretreated relapsed/refractory follicular lymphoma (R/R FL). METHODS: PROs were assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core 30 (EORTC QLQ-C30) and EQ-5D-5L questionnaires at baseline and subsequently every 12 weeks. All QLQ-C30 domains and EQ-5D-5L visual analog scale (VAS) scores were analyzed descriptively. At the key clinical timepoints (weeks 12 and 24), a mixed model for repeated measures (MMRM) analysis was used to evaluate the key PRO endpoints, including global health status, physical and role functioning, and symptoms of fatigue, pain, diarrhea, and nausea/vomiting. Clinically meaningful change was defined as a ≥5-point mean difference from baseline and between the ZO and O arms. RESULTS: Patients were randomized to ZO (n = 145) or O (n = 72). By week 48, descriptive analysis results indicated that patients in the ZO arm demonstrated improved outcomes in role functioning and fatigue and nausea/vomiting symptoms, compared with those in the O arm. Both groups experienced improvements in pain symptoms. EQ-5D-5L VAS scores showed no observable differences between treatment arms through week 48. MMRM analysis revealed that the global health status/quality of life of patients treated with ZO improved, as did fatigue, at week 12. At week 24, patients in the ZO arm experienced a clinically meaningful improvement in role functioning, pain, and fatigue. CONCLUSIONS: In patients with R/R FL, ZO was associated with improved PROs compared with O. These findings suggest that zanubrutinib contributed clinically meaningful benefits to patient HRQoL when added to obinutuzumab.

Follicular lymphoma (or FL) is a common blood cancer where abnormal white blood cells form lumps in organs and glands in the body that normally help fight infection (lymph nodes). Zanubrutinib selectively blocks Bruton tyrosine kinase, which can prevent cancer cells growing and lead to their death. Obinutuzumab binds to a protein called CD20 on cancer cells, facilitating their removal using the body's natural defense system. Previous results from the ROSEWOOD trial showed that zanubrutinib plus obinutuzumab had improved cancer-fighting effects versus obinutuzumab alone, with manageable side effects in patients whose cancer returned after treatment or when treatment had failed.

Food is Medicine National Summit: Transforming Health Care.

Food Is Medicine (FIM) interventions reflect the critical links between food security, nutrition security, health, and health equity, integrated into health care delivery. They comprise programs that provide nutritionally-tailored food, free of charge or at a discount, to support disease management, disease prevention, or optimal health, linked to the health care system as part of a patient's treatment plan. Such programs often prioritize health equity. On April 26-27, 2023, Tufts University's Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy and Food & Nutrition Innovation Institute held a two-day National Food is Medicine Summit with leaders, practitioners, and individuals with diverse lived experiences in health care, research, government, advocacy, philanthropy, and the private sector to identify challenges and opportunities to sustainably incorporate FIM services into the health care system and at scale. This report of a meeting describes key themes of the Summit, based on presentations and discussions on momentum around FIM, incorporating FIM in health care, tradeoffs and unintended consequences of various FIM models, scaling of programs, financing and payment mechanisms, educating and engaging the health care workforce, and federal and state government actions and opportunities on FIM. Speakers highlighted examples of recent public and private sector actions on FIM and innovative cross-sector partnerships, including state Medicaid waivers, academic and philanthropic research initiatives, health care system screenings and interventions, and collaborations including community-based organizations and/or entities outside of the food and health care sectors. Challenges and opportunities to broader implementation and scaling of FIM programs identified include incorporating FIM into health care business models, educating the health care workforce, and sustainably scaling FIM programs while leveraging the local connections of community-based organizations. This meeting report highlights recent advances, best practices, challenges, and opportunities discussed at the National Summit to inform future actions on FIM.

Data-Aided Maximum Likelihood Joint Angle and Delay Estimator Over Orthogonal Frequency Division Multiplex Single-Input Multiple-Output Channels Based on New Gray Wolf Optimization Embedding Importance Sampling.

In this paper, we propose a new data-aided (DA) joint angle and delay (JADE) maximum likelihood (ML) estimator. The latter consists of a substantially modified and, hence, significantly improved gray wolf optimization (GWO) technique by fully integrating and embedding within it the powerful importance sampling (IS) concept. This new approach, referred to hereafter as GWOEIS (for "GWO embedding IS"), guarantees global optimality, and offers higher resolution capabilities over orthogonal frequency division multiplex (OFDM) (i.e., multi-carrier and multi-path) single-input multiple-output (SIMO) channels. The traditional GWO randomly initializes the wolfs' positions (angles and delays) and, hence, requires larger packs and longer hunting (iterations) to catch the prey, i.e., find the correct angles of arrival (AoAs) and time delays (TDs), thereby affecting its search efficiency, whereas GWOEIS ensures faster convergence by providing reliable initial estimates based on a simplified importance function. More importantly, and beyond simple initialization of GWO with IS (coined as IS-GWO hereafter), we modify and dynamically update the conventional simple expression for the convergence factor of the GWO algorithm that entirely drives its hunting and tracking mechanisms by accounting for new cumulative distribution functions (CDFs) derived from the IS technique. Simulations unequivocally confirm these significant benefits in terms of increased accuracy and speed Moreover, GWOEIS reaches the Cramér-Rao lower bound (CRLB), even at low SNR levels.

Examining Food Security, Fruit and Vegetable Intake, and Cardiovascular Disease Risk Outcomes of Produce Prescription (PPR) Programs: A Systematic Review.

OBJECTIVE: Outcomes from produce prescription (PPR) programs, an exemplar of a Food is Medicine intervention, have not been synthesized. The objective of this study was to conduct a systematic review to examine the impact of PPR programs on food security, fruit and vegetable (FV) intake, and/or cardiovascular risk factors (HbA1c, blood pressure, and blood lipids). DESIGN: Searches were conducted across three databases (PubMed, CINAHL, and Web of Science). Eligible studies were published between August 2012 and April 2023, conducted in the US in child/family, or adult populations, written in English and had a PPR program as an exposure. OUTCOMES VARIABLES MEASURED: Food security, FV intake, and/or cardiovascular risk factors. RESULTS: Twenty studies ranging from a duration of between 6 weeks to 24 months were included. Of the 5 studies (3 in child/family and 4 in adult populations) that analyzed changes in food security status, all reported significant (P < 0.05) improvements after the PPR program. Approximately half of the included studies found significant (P < 0.05) increases in fruit, vegetable, and/or FV intake. Only studies in adult populations included cardiovascular risk factor outcomes. In these studies, mixed findings were reported; however, there were significant (P < 0.05) improvements in HbA1c when PPR programs enrolled individuals with type 2 diabetes. CONCLUSIONS AND IMPLICATIONS: PPR programs provide an opportunity to improve food security in child/family, and adult populations. Evidence to support whether PPR programs increase FV intake and improve cardiovascular disease risk factors outside of HbA1c in adult populations with high HbA1c upon enrollment is less known.

Advancing nutrition knowledge, skills, and attitudes in medical education and training: key themes and recommendations from the 2023 Summit.

The incorporation of comprehensive nutrition education into medical education and training is essential for equipping physicians with the knowledge and skills necessary to enhance patient health and outcomes. However, a deficiency in nutrition education persists in medical education, rendering physicians ill-prepared to address the vital role of nutrition in health and disease. This article summarizes the key themes and recommendations generated during the Summit on Medical Education in Nutrition, hosted in March 2023 by the Accreditation Council for Graduate Medical Education in collaboration with American Association of Colleges of Osteopathic Medicine and Association of American Medical Colleges.

A global scoping review of adaptations in nurturing care interventions during the COVID-19 pandemic.

Background: During the COVID-19 pandemic, children faced a disproportionate burden of malnutrition and poor health outcomes. Nurturing care interventions (NCIs) including actions toward good health, adequate nutrition, responsive care, opportunities for early learning, and security and safety are critical for promoting equity. Due to the need for evidence-based responses and preparedness, we analyzed adaptations in NCIs' implementation strategies during COVID-19 according to the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS). Method: We conducted a global scoping review including peer-reviewed and non-peer-reviewed literature. The databases searched were PubMed, Embase, Scopus, BVS, Scielo, and Web of Science. This search was complemented by an extensive examination of relevant websites and an additional internet search via Google Scholar. We extracted and analyzed the data following the seven modules of the FRAME-IS. Results: Out of 20 records, 27 NCI were identified across Africa (n = 3), Asia (n = 7), Europe (n = 3), North America (n = 11), Oceania (n = 1), and South America (n = 2). NCIs adapted their content (e.g., adding elements), evaluation (e.g., conducting needs assessment), training (e.g., using experts), and context (e.g., setting-shifting from in-person to remote, and population-expanding interventions' reach). Adaptation goals were to increase acceptability (n = 9, 32.1%), adoption (n = 5, 17.8%), appropriateness (n = 10, 35.7%), feasibility (n = 25, 89.3%), penetration (n = 15, 53.6%), sustainability (n = 23, 82.1%), and fidelity (n = 1, 3.7%). The rationale to adapt varied from sociopolitical (n = 6, 21.4%), organizational (n = 13, 46.4%), implementer (n = 11, 39.3%), practitioner (n = 15, 53.6%), and recipient (n = 11, 39.3%). A quarter were reactive planned adaptations and 75.0% were unplanned modifications. Decisions were led by program leaders (n = 21, 75.0%), funders (n = 9, 32.1%), partners (n = 3, 10.7%), researchers (n = 1, 3.6%), and practitioners (n = 3, 10.7%). Adaptations were widespread from unit (e.g., hospital) (n = 1, 3.6%), organization (n = 4, 14.3%), and community system (e.g., countrywide) (n = 14, 50.0%). Conclusion: The results from our global scoping review show that it is possible for NCIs to continue and even improve their delivery despite the global crisis, suggesting that remote delivery is feasible and can work as an alternative when in lockdown. Strategic planning taking advantage of existing structures and partnerships may have allowed NCI adaptations to be sustainable as well as facilitated replication within the organization network system.

Clinical Applicability of Microbiota Sampling in a Subfertile Population: Urine versus Vagina.

The urogenital microbiota is increasingly gaining recognition as a significant contributor to reproductive health. Recent studies suggest that microbiota can serve as predictors for fertility treatment outcomes. Our objective was to investigate the degree of similarity in microbial composition between patient-collected urine and vaginal samples in a subfertile population. We enrolled women of reproductive age (20-44 years) diagnosed with subfertility and requiring in vitro fertilization (IVF) or IVF with intracytoplasmic sperm injection (IVF-ICSI) treatment. They self-collected both mid-stream urine samples and vaginal swabs before commencing the IVF or IVF-ICSI procedure. All samples were analysed using the intergenic spacer profiling (IS-pro) technique, a rapid clinical microbiota analysis tool. The main outcome measures were the degree of similarity of microbial composition between the two different, but simultaneously collected, samples. Our findings revealed a high correlation (R squared of 0.78) in microbiota profiles between paired urine and vaginal samples from individual patients. Nevertheless, the urinary microbiota profiles contained fewer species compared to the vaginal microbiota, resulting in minor but distinguishable differences. Furthermore, different subfertility diagnoses appeared to be associated with differences in microbial profiles. A noteworthy observation was the exclusive presence of Escherichia coli (E. coli) in both samples of women diagnosed with male factor subfertility. In conclusion, since urinary microbiota profiles seem to represent a diluted version of the vaginal microbiota, vaginal microbiome sampling to predict fertility treatment outcome seems preferable. To enhance the success of fertility treatments, further research is needed to gain deeper insights into a putative causal role of microbiota in the mechanisms of subfertility.

The prevalence of the risk factors associated with cardiovascular diseases among Iranian adults: Findings of a cross-sectional study.

BACKGROUND: Cardiovascular diseases are among the leading causes of death worldwide. Lack of accurate estimation of the risk factors associated with these diseases can impair the designing of effective interventions in this field; the present study aimed to investigate the risk factors attributable to cardiovascular diseases in males and females visiting comprehensive health service centers in 2018. MATERIAL AND METHOD: This cross-sectional study is part of the national health transformation plan shaped in response to the emerging epidemic of noncommunicable diseases. In the present study, 6,331 participants aged 30 years and older were randomly and census selected from comprehensive urban and rural health service centers in Naein County, in Isfahan, Iran, respectively. The data were collected using the electronic health record from the IraPEN program in two sections: demographic information and the prevalence of cardiovascular disease risk factors. They were then analyzed with Statistical Package for the Social Sciences (SPSS) 24 software using descriptive statistics, Chi-square test, one-way ANOVA, and logistic regression. RESULTS: The participants' mean age was 55.09 ± 16.11 years. The main risk factor was insufficient consumption of fruits and vegetables while smoking was a negligible risk factor. Low physical activity, diabetes, hypertension, hypercholesterolemia, and high body mass index were more prevalent in females than in males, whereas smoking was more frequently reported in males (P < 0.001). Risk factors such as age, gender, education level, place of residence, and marital status, played a significant role in determining CVD risk factors. DISCUSSION: More than half of Iranian adults had one or older cardiovascular disease-related risk factors, and the prevalence of such factors was higher in females than in males. Given the importance of gender differences in cardiovascular disease-related health habits, it is necessary to reduce the majority of these diseases in society, especially in women, by controlling modifiable risk factors.

Cosmos, mind, matter: Is mind in spacetime?

We attempt in this article to formulate a conceptual and testable framework weaving Cosmos, Mind and Matter into a whole. We build on three recent discoveries, each requiring more evidence: i. The particles of the Standard Model, SU(3) × SU(2) × U(1), are formally capable of collective autocatalysis. This leads us to ask what roles such autocatalysis may have played in Cosmogenesis, and in trying to answer, Why our Laws? Why our Constants? A capacity of the particles of SU(3) × SU(2) × U(1) for collective autocatalysis may be open to experimental test, stunning if confirmed. ii. Reasonable evidence now suggests that matter can expand spacetime. The first issue is to establish this claim at or beyond 5 sigma if that can be done. If true, this process may elucidate Dark Matter, Dark Energy and Inflation and require alteration of Einstein's Field Equations. Cosmology would be transformed. iii. Evidence at 6.49 Sigma suggests that mind can alter the outcome of the two-slit experiment. If widely and independently verified, the foundations of quantum mechanics must be altered. Mind plays a role in the universe. That role may include Cosmic Mind.

Engineering IscB to develop highly efficient miniature editing tools in mammalian cells and embryos.

The IscB proteins, as the ancestors of Cas9 endonuclease, hold great promise due to their small size and potential for diverse genome editing. However, their activity in mammalian cells is unsatisfactory. By introducing three residual substitutions in IscB, we observed an average 7.5-fold increase in activity. Through fusing a sequence-non-specific DNA-binding protein domain, the eIscB-D variant achieved higher editing efficiency, with a maximum of 91.3%. Moreover, engineered ωRNA was generated with a 20% reduction in length and slightly increased efficiency. The engineered eIscB-D/eωRNA system showed an average 20.2-fold increase in activity compared with the original IscB. Furthermore, we successfully adapted eIscB-D for highly efficient cytosine and adenine base editing. Notably, eIscB-D is highly active in mouse cell lines and embryos, enabling the efficient generation of disease models through mRNA/ωRNA injection. Our study suggests that these miniature genome-editing tools have great potential for diverse applications.

GLP-1 Receptor Agonists Among Patients With Overweight or Obesity, Diabetes, and HFpEF on SGLT2 Inhibitors.

BACKGROUND: Although the use of glucagon-like peptide-1 receptor agonist (GLP-1 RA) in patients with obesity and heart failure with preserved ejection fraction (HFpEF) has demonstrated improvement in cardiovascular outcomes, the incremental benefits of GLP-1 RA for patients already on sodium-glucose cotransporter 2 inhibitors (SGLT2is) remain underexplored. OBJECTIVES: This study aimed to assess the incremental benefits of GLP-1 RA in patients with type 2 diabetes mellitus, overweight/obesity, and HFpEF receiving SGLT2i therapy. METHODS: The authors conducted a retrospective cohort study using the TriNetX research database including patients ≥18 years with type 2 diabetes mellitus, body mass index ≥27 kg/m2, and HFpEF on SGLT2i. Two cohorts were created based on GLP-1 RA prescription. The outcomes were heart failure exacerbation, all-cause emergency department visits/hospitalizations among others over a 12-month period. RESULTS: A total of 7,044 patients remained in each cohort after propensity score matching. There was a significantly lower risk of heart failure exacerbations, all-cause emergency department visits/hospitalizations, new-onset atrial arrhythmias, new-onset acute kidney injury, and pulmonary hypertension in the GLP-1 RA plus SGLT2i cohort compared with the SGLT2i-only cohort. The associated benefits persisted across different body mass indexes and ejection fractions as well as in patients with elevated natriuretic peptide. The risk of diabetic retinopathy was higher in the combination therapy group than with SGLT2i-only use. CONCLUSIONS: GLP-1 RA, in addition to SGLT2i, was associated with a significantly lower risk of heart failure hospitalizations in this patient population, suggesting a potential incremental benefit. This highlights the need for prospective studies to confirm the clinical benefits.

Exercise referral schemes increase Patients' cardiorespiratory Endurance: A systematic review and Meta-Analysis.

Introduction: The efficacy of exercise referral schemes (ERS) involving primary care providers to an exercise specialist on patients' physical activity is uncertain and primarily based on self-report outcomes. Cardiorespiratory endurance carries clinically relevant information and is an objective outcome measure that has been used to evaluate ERS, but this literature has not been amalgamated. We determined the effectiveness of ERS involving qualified exercise professionals (QEPs) on patients' cardiorespiratory endurance. Methods: A systematic review with between-group and within-group meta-analyses was performed to examine the effects of ERS on cardiorespiratory endurance. We searched Scopus, EMBASE, MEDLINE, CINAHL, and Academic Search Premier databases from their inception to February 2023 to find ERS interventions (randomized/non-randomized, controlled/non-controlled). To be included, studies required an adult patient referral from a primary care provider to a QEP. Results: Twenty-nine articles comprising 6326 (3684 females) unique patients were included. Patients were primarily older (62 ± 9 years; range: 48-82) and overweight (body mass index: 28.9 ± 7.5 kg/m2; range: 22.5-37.1). Improvements in patients' cardiorespiratory endurance were observed in 20 of the 29 studies. Among controlled studies (n = 14), the meta-analysis exhibited a favorable effect on cardiorespiratory endurance between the intervention and the comparator groups (Hedge's g: 0.31, 95 % CI: 0.09 to 0.52). The ERS interventions also improved cardiorespiratory endurance when comparing pre- and post-intervention effects (all studies, Cohen's d: 0.57, 95 % CI: 0.45 to 0.69). Conclusion: ERS that incorporate a QEP lead to improvements in patients' cardiorespiratory endurance, providing support for the creation of these programs to help patients lead healthier lifestyles.

Reaching out to fathers in Afro-Caribbean contexts: a case study review of best practices from the Fatherhood is Sacred program in native communities.

Historical trauma has played a significant role in the difficulties of fathers to fulfill their coparenting roles in Native American communities. This pattern is also true for men in Afro-Caribbean communities. Fatherhood programs developed by the Native American Fatherhood and Family Association (NAFFA) have shown effectiveness in supporting fathers, enhancing their confidence and coparenting skills, and overcoming trauma in Native communities. This paper seeks to identify the opportunities and best practices for cross-cultural adaptation of the Fatherhood is Sacred program to Afro-Caribbean families and contexts.

Is "Less be More" Still a Valid Concept in Intensive Care? A Review of Critical Care Randomized Clinical Trials from the New England Journal of Medicine.

The concept of "Less is more" has been gaining increasing awareness and acceptance in Critical Care. In 2017, we attempted to systematically answer the question "Can less be more in intensive care" with empirical data. We reviewed all the critical care randomized clinical trials (RCTs) between 1 January 2008 and 5 October 2016 in the New England Journal of Medicine (NEJM). This article attempts to repeat the earlier exercise using data from 5 October 2016 to 31 December 2023. This analysis of critical care RCTs in the NEJM has shown three findings. Approximately three-quarter of RCTs in critical care in the NEJM between 2008 and 2023 failed to show benefit or harm. In the years 2008-2016, patients in the intervention cohort had a higher mortality compared to controls, but in the years 2016-2023, the difference in overall mortality in patients in the intervention and control arms was not statistically significant. Compared to the years 2008-2016, in the years from 2016 to 2023, the number of RCTs showing harm decreased and those showing benefit increased. How to cite this article: Kapadia F, Bharadwaj S, Sharma R. Is "Less be More" Still a Valid Concept in Intensive Care? A Review of Critical Care Randomized Clinical Trials from the New England Journal of Medicine. Indian J Crit Care Med 2024;28(6):533-551.

Local Genomic Surveillance of Invasive Streptococcus pyogenes in Eastern North Carolina (ENC) in 2022-2023.

The recent increase in Group A Streptococcus (GAS) incidences in several countries across Europe and some areas of the Unites States (U.S.) has raised concerns. To understand GAS diversity and prevalence, we conducted a local genomic surveillance in Eastern North Carolina (ENC) in 2022-2023 with 95 isolates and compared its results to those of the existing national genomic surveillance in the U.S. in 2015-2021 with 13,064 isolates. We observed their epidemiological changes before and during the COVID-19 pandemic and detected a unique sub-lineage in ENC among the most common invasive GAS strain, ST28/emm1. We further discovered a multiple-copy insertion sequence, ISLgar5, in ST399/emm77 and its single-copy variants in some other GAS strains. We discovered ISLgar5 was linked to a Tn5801-like tetM-carrying integrative and conjugative element, and its copy number was associated with an ermT-carrying pRW35-like plasmid. The dynamic insertions of ISLgar5 may play a vital role in genome fitness and adaptation, driving GAS evolution relevant to antimicrobial resistance and potentially GAS virulence.

New concept in selecting blue dye injection site effect on clinical outcome of early-stage breast cancer patients: a retrospective cohort.

BACKGROUND: Clinico-anatomical review and pilot studies demonstrated that intraparenchymal injection at any site, even those not containing the index lesion, or periareolar injections should provide concordant outcomes to peritumoral injections. METHOD: This was a single-center retrospective cohort at King Chulalongkorn Memorial Hospital. The electronic medical records of patients were characterized into conventional and new injection concept groups. The inclusion criteria were patients who had either a mastectomy or BCS along with SLNB. We excluded patients who underwent ALND, received neoadjuvant therapy, or had non-invasive breast cancer. The primary outcome was the 5-year rate of breast cancer regional recurrence. Additionally, we reported on the re-operation rate, disease-free period, distant disease-free period, mortality rate, and recurrence rates both locoregional and systemic. Recurrences were identified through clinical assessments and imaging. SURGICAL TECHNIQUE: 3 ml of 1%isosulfan blue dye was injected, with the injection site varying according to the specific concept being applied. In cases of SSM and NSM following the new concept, the blue dye was injected at non-periareolar and non-peritumoral sites. After the injection, a 10-minute interval was observed without massaging the injection site. Following this interval, an incision was made to access the SLNs, which were subsequently identified, excised, and sent for either frozen section analysis or permanent section examination. RESULT: There were no significant differences in DFS, DDFS or BCSS between the two groups (p = 0.832, 0.712, 0.157). Although the re-operation rate in the NI group was approximately half that of the CI group, this difference was not statistically significant (p = 0.355). CONCLUSION: Our study suggests that tailoring isosulfan blue dye injection site based on operation type rather than tumor location is safe and effective approach for SLN localization in early-stage breast cancer. However, this study has limitations, including being a single-center study with low recurrence and death cases. Future studies should aim to increase the sample size and follow-up period.

Enhancing cultural humility in food is medicine services: A mixed-methods investigation of patient food and dietary preferences.

Dietary inequities, influenced by sociocultural and economic factors, significantly affect health outcomes, particularly among underserved communities. To address these disparities, the Food is Medicine (FIM) movement strives to enhance access to nutritious food, provide education, and encourage behavioral changes. Boston Medical Center (BMC) 's Nourishing Our Community Program (NOCP) exemplifies this mission by offering FIM services such as an on-site food pantry, rooftop farm, and teaching kitchen. However, persistent barriers hinder the effectiveness of programs like NOCP. This quality improvement (QI) project employed mixed methods to refine existing and develop new patient-generated nutrition education materials and resources across various FIM services. METHODS: This QI project included surveys and focus groups conducted electronically and in person between January and May 2023. We analyzed the data using descriptive statistics and qualitative content analysis. RESULTS: The analysis of results revealed patient preferences and experiences regarding dietary patterns, food choices, and nutrition education. These findings enhanced existing handouts, websites, and group class curricula and forged new partnerships with local community-based organizations. CONCLUSION: Our findings underpin the importance of co-designing interventions, dynamic and multimodal resources, and cultural humility in care to meet individual needs. IMPLICATIONS: This initiative is a model for hospitals aiming to improve educational resources within FIM services and tailor content to the specific needs of diverse patient populations. This project is the first step in programmatic improvement, and continuous refinement is crucial for sustained improvements and advancing health equity at our institution.

Analysis of indoxyl sulfate in biological fluids with emphasis on sample preparation techniques: A comprehensive analytical review.

The uremic toxin indoxyl sulfate (IS) has been related to the development of various medical conditions notably chronic kidney disease (CKD). Hence, quantification of this biomarker in biological fluids may be a diagnostic tool to evaluate renal system functionality. Numerous analytical methods including liquid chromatography, gas chromatography, spectroscopy, and electrochemical techniques have since been used to analyze IS in different biological fluids. The current review highlights the relevant studies that assessed IS with a special focus on sample preparation, which is essential to reduce or eliminate the effect of endogenous components from the matrix in bioanalysis.

[The last illness of I.S. Turgenev].

The article discusses the causes and course of the last illness of I.S. Turgenev. The writer was consulted by many famous French and Russian doctors who made various diagnoses and used various methods of treatment. The primary disease that caused Turgenev's death is myxosarcoma (one of the sarcoma variants), involving soft tissues and thoracic vertebrae. The article presents data and discusses alternative diagnostic versions about the nature of the disease and the causes of death of the great Russian writer.