Rosiglitazone improves insulin resistance but does not improve exercise capacity in individuals with impaired glucose tolerance: A randomized clinical study.

Dysmetabolic states, such as type 2 diabetes (T2D), characterized by insulin resistance (IR), are associated with fatty liver, increased cardiovascular disease (CVD) risk, and decreased functional exercise capacity (FEC). Rosiglitazone (RO) improves exercise capacity and IR in T2D. However, the effects of RO on FEC and other markers of CVD risk in prediabetes are unknown. We hypothesized that insulin sensitization with RO would improve exercise capacity and markers of CVD risk in participants with impaired glucose tolerance (IGT). Exercise performance (peak oxygen consumption and oxygen uptake kinetics), IR (homeostasis model assessment of IR and quantitative insulin sensitivity check index), and surrogate cardiovascular endpoints (coronary artery calcium (CAC) volume and density and C-reactive protein (CRP)) were measured in participants with IGT after 12 and 18 months of RO or placebo (PL). RO did not significantly improve exercise capacity. Glycemic measures and IR were significantly lower in people on RO compared to PL at 18 months. CAC volume progression was not different between PL and RO groups. RO did not improve exercise capacity during an 18-month intervention despite improved IR and glycemia in people with IGT. Future studies should explore why effects on FEC with RO occur in T2D but not IGT. Understanding these questions may help in targeting therapeutic approaches in T2D and IGT.

Sexual Assault Nurse Examiner Education Needs in Texas.

ABSTRACT: Background: As with many areas of the nation, Texas lacks a robust sexual assault nurse examiner (SANE) workforce. A program in Texas offers courses to educate and expand SANE skills to better provide trauma-informed care to vulnerable populations. Methods: A survey to stakeholders of a SANE educational program, as part of a planned program evaluation, elicited not only barriers to providing care but also specific program needs to better expand access to sexual assault and domestic violence medical forensic examinations in Texas. Results: In January 2022, a total of 40 stakeholders, all registered nurses in the state of Texas, provided vital information on their current program. Analysis of written survey responses provided themes regarding barriers to providing SANE care and suggestions for expanded education. Discussion: The survey provided valuable feedback and comments on the perceptions of the current SANE program. Written responses offered direction for additional learning desires of SANEs associated with the program as well as areas for the program to expand to meet the needs of the learners. This stakeholder guidance has implications beyond this one SANE education program to enhance and expand other programs based on learner needs.

Innovative Pedagogical Approaches to Teaching Advanced Forensic Nursing.

Forensic nursing is a specialty in nursing with unique knowledge and skills, founded on a theoretic framework identifying three pillars of knowledge--legal principles, forensic science, and forensic nursing with concepts, context, and content unique to the specialty. To care for patients with trauma backgrounds, who are or have intersected with the legal system, forensic nursing education and subsequent certification today requires educational technology. Transforming learning takes demonstrative activities, changing them into interactive dynamic opportunities that teach metacognitive activities to provide complex trauma-informed care in the aftermath of violence, to forensic nurses.

Increasing Access to Forensic Nursing Services in Rural and Underserved Areas of Texas.

ABSTRACT: Sexual assault is prevalent in the Unites States. Many areas of the country lack access to sexual assault nurse examiners (SANEs), especially in rural areas. The U.S. Health Resources and Services Administration Advanced Nursing Education-Sexual Assault Nurse Examiner educational grant provided an opportunity to improve equity and reduce disparity in rural and underserved communities by offering education and simulation experiences in the care of sexual assault patients. Through the Texas A&M Health Center of Excellence in Forensic Nursing, Texas A&M University College of Nursing developed an innovative program using simulated medical forensic examinations and mock testimony education. Rapid cycle quality improvement was utilized to adapt quickly to feedback and meet overarching goals. This article describes development and adaptation of the program using rapid cycle quality improvement processes and progress in recruitment, retention, and certification of nurses to provide sexual assault care in rural and underserved areas of Texas.

Molecular evolution of the transferrin receptor/glutamate carboxypeptidase II family.

The transferrin receptor family is represented by at least seven different homologous proteins in primates. Transferrin receptor (TfR1) is a type II membrane glycoprotein that, as a cell surface homodimer, binds iron-loaded transferrin as part of the process of iron transfer and uptake. Other family members include transferrin receptor 2 (TfR2), glutamate carboxypeptidase II (GCP2 or PSMA), N-acetylated alpha-linked acidic dipeptidase-like protein (NLDL), N-acetylated alpha-linked acidic dipeptidase 2 (NAALAD2), and prostate-specific membrane antigen-like protein (PMSAL/GCPIII). We compared 86 different sequences from 24 different species, from mammals to fungi. Through this comparison, we have identified several highly conserved residues specific to each family not previously associated with clinical mutations. The evolutionary history of the TfR/GCP2 family shows repeated episodes of duplications consistent with recent theories that nondispensable, slowly evolving genes are more likely to form multiple gene families.

Do medical examiners determine elder mistreatment as a cause of death?

This study examines the decision-making process of medical examiners in determining elder mistreatment in cases that present to the county morgue. Harris County Medical Examiners were surveyed about factors that influence the determination whether elder abuse or neglect was a contributor to the cause of death. At the time of the survey, all 11 Harris County Medical Examiners participated. Of these, 8 did not determine elder abuse or neglect as contributing to the cause of death in the 12 months prior to the survey, 6 reported that medical records were helpful "all the time", 3 reported "most of the time", and 2, indicated that the records were "some-times helpful". The survey also indicated that information that assists medical examiners in identifying the potential for abuse or neglect ranged from "present most of the time" to "never present". Multiple factors including autopsy findings, medical compliance, inconsistency in injury findings, and malnutrition were reported as helpful in determining elder abuse or neglect. Further studies are needed to determine additional factors that would provide medical examiners with the ability to more readily identify signs of elder abuse or neglect.