A Call for Transformative Intersectional LPAA Intervention for Equity and Social Justice in Ethnosocially Diverse Post-Stroke Aphasia Services.

The disproportionate health disparities in ethnoracial groups highlighted by the COVID-19 pandemic catalyzed a sociopolitical momentum for transformative approaches in health care. As the U.S. population progressively becomes more ethnoracially diverse and older, growing vulnerable ethnogeriatric groups of older individuals with contrasting ethnic/racial and social histories are estimated to experience age-related cardiovascular complications with resulting chronic disabilities, such as post-stroke aphasia. Grounded in principles of equity and social justice, transformative health care approaches use input from marginalized communities to inform service strategies to minimize health disparities. This article discusses the population scenario, principles, and possible strategies to support the call for stakeholder-informed intervention toward the social reintegration of ethnosocially mixed geriatric populations with aphasia in the United States. Based on the principles from the Life Participation Approach to Aphasia (LPAA) and intersectional narratives, we discuss how client and caregiver stories can inform culturally authentic individualized aphasia intervention for social readaptation. We conclude with future directions in aphasia education, research, and practice to promote stakeholder-informed strategies for culturally aligned social reintegration of older ethnosocially diverse aphasia populations in post-stroke care.

Factors Influencing Bacterial and Fungal Skin Communities of Montane Salamanders of Central Mexico.

Host microbial communities are increasingly seen as an important component of host health. In amphibians, the first land vertebrates that are threatened by a fungal skin disease globally, our understanding of the factors influencing the microbiome of amphibian skin remains incomplete because recent studies have focused almost exclusively on bacteria, and little information exists on fungal communities associated with wild amphibian species. In this study, we describe the effects of host phylogeny, climate, geographic distance, and infection with a fungal pathogen on the composition and structure of bacterial and fungal communities in seven tropical salamander species that occur in the Trans-Mexican Volcanic Belt of Central Mexico. We find that host phylogenetic relatedness is correlated with bacterial community composition while a composite climatic variable of temperature seasonality and precipitation is significantly associated with fungal community composition. We also estimated co-occurrence networks for bacterial and fungal taxa and found differences in the degree of connectivity and the distribution of negative associations between the two networks. Our results suggest that different factors may be responsible for structuring the bacterial and fungal communities of amphibian skin and that the inclusion of fungi in future studies could shed light on important functional interactions within the microbiome.

Electrostatic hindrance to diffusion in flexible crosslinked gels: A coarse-grained simulation study.

In this work, we study how electrostatic forces slow down the diffusion of solute in flexible gels through coarse-grained simulations. The model used explicitly considers the movement of solute particles and polyelectrolyte chains. These movements are performed by following a Brownian dynamics algorithm. The effect of three electrostatic parameters characterizing the system (solute charge, polyelectrolyte chain charge, and ionic strength) is analyzed. Our results show that the behavior of both the diffusion coefficient and the anomalous diffusion exponent changes upon the reversal of the electric charge of one of the species. In addition, the diffusion coefficient in flexible gels differs significantly from that in rigid gels if the ionic strength is low enough. However, the effect of chain flexibility on the exponent of anomalous diffusion is significant even at high ionic strength (100 mM). Our simulations also prove that varying the polyelectrolyte chain charge does not have exactly the same effect as varying the solute particle charge.

Cerebroprotective Effect of 17ß-Estradiol Replacement Therapy in Ovariectomy-Induced Post-Menopausal Rats Subjected to Ischemic Stroke: Role of MAPK/ERK1/2 Pathway and PI3K-Independent Akt Activation.

Despite the overwhelming advances in the understanding of the pathogenesis of stroke, a devastating disease affecting millions of people worldwide, currently there are only a limited number of effective treatments available. Preclinical and clinical studies show that stroke is a sexually dimorphic disorder, affecting males and females differently. Strong experimental evidence indicates that estrogen may play a role in this difference and that exogenous 17ß-estradiol (E2) is neuroprotective against stroke in both male and female rodents. However, the molecular mechanisms by which E2 intervenes in ischemia-induced cell death, revealing these sex differences, remain unclear. The present study was aimed to determine, in female rats, the molecular mechanisms of two well-known pro-survival signaling pathways, MAPK/ERK1/2 and PI3K/Akt, that mediate E2 neuroprotection in response to acute ischemic stroke. E2 pretreatment reduced brain damage and attenuated apoptotic cell death in ovariectomized female rats after an ischemic insult. Moreover, E2 decreased phosphorylation of ERK1/2 and prevented ischemia/reperfusion-induced dephosphorylation of both Akt and the pro-apoptotic protein, BAD. However, MAPK/ERK1/2 inhibitor PD98059, but not the PI3K inhibitor LY294002, attenuated E2 neuroprotection. Thus, these results suggested that E2 pretreatment in ovariectomized female rats modulates MAPK/ERK1/2 and activates Akt independently of PI3K to promote cerebroprotection in ischemic stroke. A better understanding of the mechanisms and the influence of E2 in the female sex paves the way for the design of future successful hormone replacement therapies.

Universal description of steric hindrance in flexible polymer gels.

In this work, the long-time diffusion of a solute in a chemically crosslinked and flexible hydrogel is computed from a bead-spring model of a polymeric network to assess the effect of steric obstruction. The relative diffusivities obtained for a wide variety of systems can be described by an exponential decay depending on a parameter that differs from that employed for rigid gels. The mathematical expression derived here can approximately predict the diffusivity in flexible gels if steric hindrance is the mechanism ruling diffusion.

Coarse-grained simulations of diffusion controlled release of drugs from neutral nanogels: Effect of excluded volume interactions.

The primary goal of this work is to assess the effect of excluded volume interactions on the diffusion controlled release of drug molecules from a spherical, neutral, inert, and cross-linked device of nanometric size. To this end, coarse-grained simulations of the release process were performed. In this way, the inner structure and topology of the polymer network can be explicitly taken into account as well. Our in silico experiments reveal that the boundary condition of constant surface concentration is not appropriate for nanogels. In particular, the predictions based on the perfect sink condition clearly overestimate the fraction of drug released. In addition, these simulations provide values for the release exponent that depends on both the diameter of drug molecules and the number of drug molecules loaded in the matrix, which clearly contrasts with the classical prediction of a constant release exponent. Consequently, the widely used classification of drug release mechanisms based on this kinetic exponent must be extended to include new situations.

Public Regulatory Databases as a Source of Insight for Neuromodulation Devices Stimulation Parameters.

OBJECTIVE: The Shannon model is often used to define an expected boundary between non-damaging and damaging modes of electrical neurostimulation. Numerous preclinical studies have been performed by manufacturers of neuromodulation devices using different animal models and a broad range of stimulation parameters while developing devices for clinical use. These studies are mostly absent from peer-reviewed literature, which may lead to this information being overlooked by the scientific community. We aimed to locate summaries of these studies accessible via public regulatory databases and to add them to a body of knowledge available to a broad scientific community. METHODS: We employed web search terms describing device type, intended use, neural target, therapeutic application, company name, and submission number to identify summaries for premarket approval (PMA) devices and 510(k) devices. We filtered these records to a subset of entries that have sufficient technical information relevant to safety of neurostimulation. RESULTS: We identified 13 product codes for 8 types of neuromodulation devices. These led us to devices that have 22 PMAs and 154 510(k)s and six transcripts of public panel meetings. We found one PMA for a brain, peripheral nerve, and spinal cord stimulator and five 510(k) spinal cord stimulators with enough information to plot in Shannon coordinates of charge and charge density per phase. CONCLUSIONS: Analysis of relevant entries from public regulatory databases reveals use of pig, sheep, monkey, dog, and goat animal models with deep brain, peripheral nerve, muscle and spinal cord electrode placement with a variety of stimulation durations (hours to years); frequencies (10-10,000 Hz) and magnitudes (Shannon k from below zero to 4.47). Data from located entries indicate that a feline cortical model that employs acute stimulation might have limitations for assessing tissue damage in diverse anatomical locations, particularly for peripheral nerve and spinal cord simulation.

The U.S. Department of Veterans' Affairs depleted uranium exposed cohort at 25 Years: Longitudinal surveillance results.

BACKGROUND: A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly-fire incidents have been monitored for health changes in a clinical surveillance program at the Veterans Affairs Medical Center, Baltimore since 1994. METHODS: During the spring of 2015, an in-patient clinical surveillance protocol was performed on 36 members of the cohort, including exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes. RESULTS: On-going mobilization of U from embedded fragments is evidenced by elevated urine U concentrations. The DU isotopic signature is observed principally in participants possessing embedded fragments. Those with only an inhalation exposure have lower urine U concentration and a natural isotopic signature. CONCLUSIONS: At 25 years since first exposure to DU, an aging cohort of military veterans continues to show no U-related health effects in known target organs of U toxicity. As U body burden continues to accrue from in-situ mobilization from metal fragment depots, and increases with exposure duration, critical tissue-specific U concentration thresholds may be reached, thus recommending on-going surveillance of this veteran cohort.

Biologic monitoring and surveillance results for the department of veterans affairs' depleted uranium cohort: Lessons learned from sustained exposure over two decades.

BACKGROUND: A small group of Gulf War I veterans wounded in depleted uranium (DU) friendly fire incidents have been monitored in a clinical surveillance program at the Veterans Affairs Medical Center, Baltimore since 1994. METHODS: An in-patient clinical surveillance protocol was performed on 35 members of the cohort, including exposure monitoring for total and isotopic uranium concentrations in urine and a comprehensive assessment of health outcomes. RESULTS: Although urine U concentrations continue to be elevated in this group, illustrating on-going in situ mobilization of U from embedded fragments, no consistent U-related health effects have been observed. CONCLUSIONS: Now more than 20 years since first exposure to DU, an aging cohort of military veterans continues to show no U-related health effects in known target organs of U toxicity. As tissue concentrations continue to accrue with exposure duration, critical tissue-specific U concentration thresholds may be reached, thus recommending on-going surveillance of this veteran cohort.

Molecular and biochemical characterization of Mottled-dappled, an embryonic lethal Menkes disease mouse model.

Mottled-dappled (Mo-dp) is a mouse model of Menkes disease caused by a large, previously uncharacterized deletion in the 5' region of Atp7a, the mouse ortholog of ATP7A. Affected mutants die in utero at embryonic day 17, and show bending and thickening of the ribs and distortion of the pectoral and pelvic girdles and limbs. To characterize this allele, we designed a custom 4x180K microarray on the mouse X chromosome and performed comparative genomic hybridization using extracted DNA from normal and carrier Mo-dp females, and identified an approximately 9 kb deletion. We used PCR to fine-map the breakpoints and amplify a junction fragment of 630 bp. Sequencing of the junction fragment disclosed the exact breakpoint locations and that the Mo-dp deletion is precisely 8990 bp, including approximately 2 kb in the promoter region of Atp7a. Western blot analysis of Mo-dp heterozygous brains showed diminished amounts of Atp7a protein, consistent with reduced expression due to the promoter region deletion on one allele. In heterozygous females, brain copper levels tended to be lower compared to wild type whereas neurochemical analyses revealed higher dihydroxyphenylacetic acid:dihydroxyphenylglycol (DOPAC:DHPG) and dopamine:norepinephrine (DA:NE) ratios compared to normal (P=0.002 and 0.029, respectively), consistent with partial deficiency of dopamine-beta-hydroxylase, a copper-dependent enzyme. Heterozygous females showed no significant differences in body weight compared to wild type females. Our results delineate the molecular details of the Mo-dp mutation for the first time and define novel biochemical findings in heterozygous female carriers of this allele.

Size-exclusion partitioning of neutral solutes in crosslinked polymer networks: a Monte Carlo simulation study.

In this work, the size-exclusion partitioning of neutral solutes in crosslinked polymer networks has been studied through Monte Carlo simulations. Two models that provide user-friendly expressions to predict the partition coefficient have been tested over a wide range of volume fractions: Ogston's model (especially devised for fibrous media) and the pore model. The effects of crosslinking and bond stiffness have also been analyzed. Our results suggest that the fiber model can acceptably account for size-exclusion effects in crosslinked gels. Its predictions are good for large solutes if the fiber diameter is assumed to be the effective monomer diameter. For solutes sizes comparable to the monomer dimensions, a smaller fiber diameter must be used. Regarding the pore model, the partition coefficient is poorly predicted when the pore diameter is estimated as the distance between adjacent crosslinker molecules. On the other hand, our results prove that the pore sizes obtained from the pore model by fitting partitioning data of swollen gels are overestimated.

Chapter 4 embedded metal fragments.

The continued evolution of military munitions and armor on the battlefield, as well as the insurgent use of improvised explosive devices, has led to embedded fragment wounds containing metal and metal mixtures whose long-term toxicologic and carcinogenic properties are not as yet known. Advances in medical care have greatly increased the survival from these types of injuries. Standard surgical guidelines suggest leaving embedded fragments in place, thus individuals may carry these retained metal fragments for the rest of their lives. Nursing professionals will be at the forefront in caring for these wounded individuals, both immediately after the trauma and during the healing and rehabilitation process. Therefore, an understanding of the potential health effects of embedded metal fragment wounds is essential. This review will explore the history of embedded fragment wounds, current research in the field, and Department of Defense and Department of Veterans Affairs guidelines for the identification and long-term monitoring of individuals with embedded fragments.

Comparison of the Influence of Oxygen Groups Introduced by Graphene Oxide on the Activity of Carbon Felt in Vanadium and Anthraquinone Flow Batteries.

An increasing number of studies focus on organic flow batteries (OFBs) as possible substitutes for the vanadium flow battery (VFB), featuring anthraquinone derivatives, such as anthraquinone-2,7-disulfonic acid (2,7-AQDS). VFBs have been postulated as a promising energy storage technology. However, the fluctuating cost of vanadium minerals and risky supply chains have hampered their implementation, while OFBs could be prepared from renewable raw materials. A critical component of flow batteries is the electrode material, which can determine the power density and energy efficiency. Yet, and in contrast to VFBs, studies on electrodes tailored for OFBs are scarce. Hence, in this work, we propose the modification of commercial carbon felts with reduced graphene oxide (rGO) and poly(ethylene glycol) for the 2,7-AQDS redox couple and to preliminarily assess its effects on the efficiency of a 2,7-AQDS/ferrocyanide flow battery. Results are compared to those of a VFB to evaluate if the benefits of the modification are transferable to OFBs. The modification of carbon felts with surface oxygen groups introduced by the presence of rGO enhanced both its hydrophilicity and surface area, favoring the catalytic activity toward VFB and OFB reactions. The results are promising, given the improved behavior of the modified electrodes. Parallels are established between the electrodes of both FB technologies.

Assessment of geographical variation in the respiratory toxicity of desert dust particles.

The health consequences of sand particle inhalation are incompletely understood. This project evaluated the respiratory toxicity of sand particles collected at military bases near Fort Irwin USA, in Iraq (Camp Victory, Taji and Talil), and Khost Afghanistan. Our primary focus was on assessing the role of soluble metals in the respiratory toxicity of the sand particles using in vitro and in vivo methods. Replicating rat type II alveolar cell cultures (RLE-6TN) were exposed to sand extracts or vehicle control in serum-free media for ≤24 h. Cytotoxicity was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and assessment of lactate dehydrogenase leakage. The relative in vitro cytotoxicity of the sand extracts was Taji ≈ Talil > Afghanistan > Camp Victory ≈ Fort Irwin. We also assessed extracts of Camp Victory, Afghanistan, and Taji sand for acute and delayed pulmonary toxicity in rats following intratracheal administration. Assessments included biochemical analysis of bronchoalveolar lavage fluid (BALF) and lung histopathology. The in vitro cytotoxicity assay results were partially predictive of in vivo responses. The more cytotoxic Taji sand extract induced an acute irritant response in rats following intratracheal administration. Rats given the less cytotoxic Camp Victory sand extract had minimal biochemical or cytological BALF changes whereas rats given either the Afghanistan or Taji sand extracts demonstrated BALF changes that were suggestive of mild lung inflammation. Unexpectedly, we observed similar lung pathology in all extract-exposed rats. The results of our study can be used to prioritize future particle inhalation studies or guide epidemiological study design.

[Bioethics through a philosophical lens: the (bio)ontological foundations of Juliana González Valenzuela's proposal]. / Bioética en clave filosófica: el fundamento (bio)ontológico desde la propuesta de Juliana González Valenzuela.

The enrichment of bioethical proposals built from and for Latin America has been increasing in recent decades. In order to contribute to this, our objective is to present a proposal for a bioethical interpretation from a philosophical approach based on the identification of central concepts of Mexican philosopher Juliana González Valenzuela. A dual bio-ontological foundation was identified: a) the "dialectic phenomenology of life," which allows the synthesis between the biological and cultural aspects of human beings, as well as the overcoming of its contradictions; and b) the Homo humanus, which enables the existence of the bio-ethical being affirmed as an authentic being and one who seeks a good life (eu-bios and eu-zoein). Reflection on and critique of the implications that the bio-ontological foundation hypothetically couples to law and power led us to identify main arguments. However, the necessary link between the bio-ethical being and said disciplines was evidenced by virtue of their social and communitarian nature (zoon politikón, ζῷον πολῑτῐκόν).

El enriquecimiento de las propuestas bioéticas construidas desde y para Latinoamérica ha ido en aumento en las últimas décadas, a efecto de contribuir a ello es que nuestro objetivo es presentar una propuesta de interpretación bioética en clave filosófica a partir de la identificación de los conceptos centrales de la filósofa mexicana Juliana González Valenzuela. Se identificó un doble fundamento bio-ontológico: a) la "fenomenología dialéctica de la vida" que permite la síntesis entre el aspecto biológico y cultural del ser humano, así como la superación de sus contradicciones; y b) el Homo humanus que posibilita la existencia del ser bio-ético afirmado en tanto un ser auténtico y en tanto busca una vida buena (eu-bíos y eu-zoein). La reflexión y crítica de las implicaciones que el fundamento bio-ontológico apareja hipotéticamente al derecho y al poder, nos llevó a identificar las principales líneas argumentativas, pero principalmente se evidenció el vínculo necesario entre el ser bio-ético y dichas disciplinas, en virtud de su naturaleza social y comunitaria (zoon politikón, ζῷον πολῑτῐκόν).

Focusing Our Attention on Socially Responsive Professional Education to Serve Ethnogeriatric Populations With Neurogenic Communication Disorders in the United States.

PURPOSE: This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders. METHOD: We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine. RESULTS: The NASEM's three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes. CONCLUSION: Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates.

Teledentistry from research to practice: a tale of nineteen countries.

Aim: The COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries. Methods: Data were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe. Results: Ten (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national (n = 5), intermediate (provincial) (n = 4) and local (n = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries. Conclusion: Despite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry.

In utero copper treatment for Menkes disease associated with a severe ATP7A mutation.

Menkes disease is a lethal X-linked recessive neurodegenerative disorder of copper transport caused by mutations in ATP7A, which encodes a copper-transporting ATPase. Early postnatal treatment with copper injections often improves clinical outcomes in affected infants. While Menkes disease newborns appear normal neurologically, analyses of fetal tissues including placenta indicate abnormal copper distribution and suggest a prenatal onset of the metal transport defect. In an affected fetus whose parents found termination unacceptable and who understood the associated risks, we began in utero copper histidine treatment at 31.5 weeks gestational age. Copper histidine (900 µg per dose) was administered directly to the fetus by intramuscular injection (fetal quadriceps or gluteus) under ultrasound guidance. Percutaneous umbilical blood sampling enabled serial measurement of fetal copper and ceruloplasmin levels that were used to guide therapy over a four-week period. Fetal copper levels rose from 17 µg/dL prior to treatment to 45 µg/dL, and ceruloplasmin levels from 39 mg/L to 122 mg/L. After pulmonary maturity was confirmed biochemically, the baby was delivered at 35.5 weeks and daily copper histidine therapy (250 µg sc b.i.d.) was begun. Despite this very early intervention with copper, the infant showed hypotonia, developmental delay, and electroencephalographic abnormalities and died of respiratory failure at 5.5 months of age. The patient's ATP7A mutation (Q724H), which severely disrupted mRNA splicing, resulted in complete absence of ATP7A protein on Western blots. These investigations suggest that prenatally initiated copper replacement is inadequate to correct Menkes disease caused by severe loss-of-function mutations, and that postnatal ATP7A gene addition represents a rational approach in such circumstances.

Diabetes impairs the atrial natriuretic peptide relaxant action mediated by potassium channels and prostacyclin in the rabbit renal artery.

Diabetes is associated with increased prevalence of hypertension, cardiovascular and renal disease. Atrial natriuretic peptide (ANP) plays an important role in cardiovascular pathophysiology and is claimed to have cardioprotective and renoprotective effect in diabetic patients. The working hypothesis was that alloxan-induced diabetes might modify the vascular effects of ANP in isolated rabbit renal arteries and the mechanisms involved in such actions. Plasma ANP levels were higher in diabetic rabbits than in control rabbits. ANP (10(-12)-10(-7)M) induced a relaxation of precontracted renal arteries, which was lower in diabetic than in control rabbits. In arteries from both groups of animals, endothelium removal decreased the ANP-induced relaxation but inhibition of NO-synthesis did not modify ANP-induced relaxations. In KCl-depolarised arteries, relaxation to ANP was almost abolished both in control and diabetic rabbits. Tetraethylammonium (TEA) partly inhibited the relaxation to ANP in control rabbits but did not modify it in diabetic rabbits. Glibenclamide and 4-aminopyridine inhibited the relaxation to ANP, and these inhibitions were lower in diabetic than in control rabbits. Indomethacin potentiated the relaxation to ANP, more in control than in diabetic rabbits. In the presence of ANP the renal artery released thromboxane A(2) and prostacyclin, and the release of prostacyclin resulted decreased in diabetic rabbits. The present results suggest that diabetes produces hyporeactivity of the rabbit renal artery to ANP by mechanisms that at least include the reduced modulation by prostacyclin and a lower participation of ATP-sensitive K(+) channel (K(ATP)), voltage-sensitive K(+) channels (K(V)) and TEA-sensitive K(+) channels (K(Ca)).