Pachymeningeal disease: a systematic review and metanalysis.

BACKGROUND: Pachymeningeal disease (PMD) is a newly recognized pattern of brain metastasis (BrM) failure that specifically occurs following surgery with adjuvant stereotactic radiosurgery (SRS) and has unique prognostic implications relative to leptomeningeal disease (LMD). Here, we report its prevalence, prognostic implications, and associated risk factors. METHODS: A literature search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses on PUBMED and Cochrane from January 2000 to June 2023. RESULTS: We identified 12 studies that included a total of 3992 BrM patients, 659 (16.5%) of whom developed meningeal disease (MD) following surgery plus adjuvant SRS, including either PMD or LMD. The mean prevalence of MD across studies was 20.9% (7.9-38.0%), with PMD accounting for 54.6% of this prevalence and LMD comprising the remaining 45.4%. Mean of the median overall survivals following diagnosis of PMD and LMD was 10.6 months and 3.7 months p = 0.007, respectively, a significant difference. Only 2 risk factors for PMD were reported in ≥ 2 studies and also identified as statistically significant per our meta-analysis: infratentorial location and controlled systemic disease status. CONCLUSION: While PMD has a superior prognosis to LMD, it is nevertheless a critical oncologic event associated with significant mortality and remains poorly recognized. PMD is predominantly observed in patients with controlled systemic disease status and infratentorial location. Future treatment strategies should focus on reducing surgical seeding and sterilizing surgical cavities.

Project ECHO for Cancer Care: a Scoping Review of Provider Outcome Evaluations.

The Project ECHO model of telementoring has been used for the past 10 years to expand access to specialized cancer care. This scoping review identifies evidence for the model's ability to improve provider outcomes, synthesizing findings from existing studies within Moore et al.'s (2009) framework for continuing medical education outcomes. We search two large research databases and a collection maintained by Project ECHO staff for articles that focus on cancer ECHO programs, involve primary data collection, and were published between December 1, 2016, and November 30, 2021. We identified 25 articles for inclusion in our scoping review. Most articles reported results for outcomes related to program participation: attendance, satisfaction, and learning. Yet, just under half reported changes in provider practices. Results demonstrate widespread participation and improved learning resulting from ECHO programs focused on cancer care. There is also evidence of improved practices related to HCV vaccination and palliative care. We highlight examples of best practices as well as opportunities to improve provider outcome evaluations for cancer ECHO programs.

Rényi Entropy in Statistical Mechanics.

Rényi entropy was originally introduced in the field of information theory as a parametric relaxation of Shannon (in physics, Boltzmann-Gibbs) entropy. This has also fuelled different attempts to generalise statistical mechanics, although mostly skipping the physical arguments behind this entropy and instead tending to introduce it artificially. However, as we will show, modifications to the theory of statistical mechanics are needless to see how Rényi entropy automatically arises as the average rate of change of free energy over an ensemble at different temperatures. Moreover, this notion is extended by considering distributions for isospectral, non-isothermal processes, resulting in relative versions of free energy, in which the Kullback-Leibler divergence or the relative version of Rényi entropy appear within the structure of the corrections to free energy. These generalisations of free energy recover the ordinary thermodynamic potential whenever isothermal processes are considered.

[Epidemiology of glomerular disease in adults: a database review]. / Epidemiología de la enfermedad glomerular en adultos. Revisión de una base de datos.

INTRODUCTION: Glomerular disease is among the top ten leading causes of death in Mexico. AIM: To assess the frequency of glomerulopathy in western Mexico in a Regional Hospital belonging of the Instituto Mexicano Del Seguro Social. METHODS: Single hospital center retrospective analysis. We reviewed all native kidney biopsies between January 2003 and December 2011, in patients more than 16 years old, to establish clinical features, presentation, and histological report. RESULTS: A total of 163 reports were analyzed; patients with a mean age of 32.6 ± 13.3 years, 55% female, 24% had systemic arterial hypertension, and 10% with a family history of chronic renal failure. The most frequent types of primary glomerulonephritis were focal segmental glomerulosclerosis (FSGS) in 47% of cases, followed by membranous nephropathy in 15%. The most frequent types of secondary glomerulonephritis were lupus nephritis in 14%, followed by diabetic nephropathy in 4% and amyloidosis in 1.2%. CONCLUSION: Focal segmental glomerulosclerosis is the most frequent type of glomerulopathy in our population; we observed a minor percentage of Inmunoglobulin A (IgA) nephropathy compared with worldwide reports. This information is a contribution to the understanding of the prevalence of glomerulopathy in western Mexico.

A Coordinated School Health Program Effect on Cardiorespiratory Fitness of South Texas Preschool Children: A Cluster Randomized Trial.

BACKGROUND: The purpose of this study was to assess the effects of the Bienestar/NEEMA Coordinated School Health Program (BN CSHP) on cardiorespiratory fitness (CRF) of preschool children. METHODS: A cluster randomized trial was conducted of preschools in South Texas. Of 48 eligible schools, 28 were randomly assigned (14 intervention, 14 control). Family demographics and household health characteristics were collected from parents and CRF from children. Generalized linear mixed model (GLMM) was used to analyze the data. RESULTS: Family demographics, household health characteristics, and children's weight, obesity prevalence, and sedentary activity of the control group were similar to the intervention group at baseline. After adjusting for covariates, the number of laps ran by children in the control group increased by 23% (CI: -5% to 60%) per each data collection period compared with 53% (CI: 7% to 119%) in the intervention group. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: State mandates, parent engagement, and funding are key for designing effective health and Physical Education (PE) programs. CONCLUSION: Children in the BN CSHP, compared to those in the control group, had a significantly higher increase in their CRF. This finding is important because of the health benefits of CRF in children. CLINICALTRIALS: gov Identifier: NCT05501392.

Early warning of atrial fibrillation using deep learning.

Atrial fibrillation (AF), the most prevalent cardiac rhythm disorder, significantly increases hospitalization and health risks. Reverting from AF to sinus rhythm (SR) often requires intensive interventions. This study presents a deep-learning model capable of predicting the transition from SR to AF on average 30.8 min before the onset appears, with an accuracy of 83% and an F1 score of 85% on the test data. This performance was obtained from R-to-R interval signals, which can be accessible from wearable technology. Our model, entitled Warning of Atrial Fibrillation (WARN), consists of a deep convolutional neural network trained and validated on 24-h Holter electrocardiogram data from 280 patients, with 70 additional patients used for testing and further evaluation on 33 patients from two external centers. The low computational cost of WARN makes it ideal for integration into wearable technology, allowing for continuous heart monitoring and early AF detection, which can potentially reduce emergency interventions and improve patient outcomes.

Sexual Enrichment Aids: A Mixed Methods Study Evaluating Use, Hygiene, and Risk Perception among Women.

Sexual Enrichment Aids (SEAs), or "sex toys" like dildos or vibrators, are used to enrich sexual experiences, either alone or with sexual partners. Although SEA use has become increasingly prevalent in recent decades, there remain significant gaps in knowledge regarding sexual behaviors and hygiene surrounding their use. In this study, we use mixed methods approaches (cross-sectional survey of n = 800 women and qualitative semi-structured interviews of n = 24 women) to better understand sexual behavior, potential risks, and hygiene practices of women who self-identify as having sex with men, with women, or with women and men when using SEAs. We identified SEA use is common, with 79.9% of women using an SEA. Among these women, 31.8% of women indicated that they share SEAs with sexual partners. Further, condom use is rare while sharing SEAs, with only 14% of women utilizing condoms regularly. The majority (81.8%) of women wash their SEAs, primarily with soap and water. Yet, there is no consensus among women interviewed regarding the perceived risk associated with SEA use. Together, our findings support the need for increased evidence-based education for women to increase safety and hygiene of SEA use.

Medical Counseling on Sexual Enrichment Aids: Women's Preferences and Medical Practitioner Expertise.

OBJECTIVE: To investigate women's preferences and experiences regarding health counseling of safe sexual enrichment aid use and hygiene and current counseling behaviors of medical practitioners on this topic. METHODS: This study used mixed methodology, leveraging quantitative data from a cross-sectional survey of 800 women and semi-structured qualitative interview data from 24 women across sexual practice groups. Additionally, we conducted a cross-sectional survey of 192 medical practitioners to understand current counseling behaviors and attitudes. RESULTS: The majority of women (96.2%, 607/631) had never been counseled by a practitioner on safe sexual enrichment aid use and hygiene but would feel comfortable receiving counseling on the subject under certain circumstances. Overwhelmingly, women indicated the need for a nonjudgmental practitioner. Many cited the importance of having a female practitioner and preferred one within obstetrics and gynecology. Among medical practitioners, counseling on this topic was infrequent; 27.0% (52/192) stated that they counsel patients on safe sexual enrichment aid use and hygiene when discussing safe sex, and 21.4% (41/192) reported that this topic is included when counseling women after a sexually transmitted infection diagnosis. Only 7.4% (14/188) and 6.4% (12/188) had received training on this topic or were aware of any professional guidelines or recommendations, respectively. CONCLUSION: Evidence-based guidelines should be developed that practitioners can use to counsel patients, ensuring that women are able to engage in sexual enrichment aid use safely.

Community health worker insights on promoting research engagement with diverse populations.

Representation of diverse populations in health research enhances our ability to understand the factors that impact health, generalize results, implement findings, and promote social justice. The primary objective of the study was to understand the unique perspectives of frontline community health workers (CHWs) to identify actionable barriers and facilitators that may impact representation of diverse groups in health research. Focus groups with CHWs were conducted followed by thematic analysis. Results revealed five main themes: barriers/risks to research participation, facilitation of research, CHW roles, recommendations, and transparency. A novel finding was that some CHWs see themselves as both facilitators and gatekeepers. As facilitators, CHWs ensure their patient populations receive resources and benefit from being involved in research; as gatekeepers CHWs feel that they protect patient populations from experiencing further trauma, especially when engaging in research. Recognizing that in many communities there is a high reliance and trust with CHWs, can promote genuine and informed participation at all stages of research.

Current Evidence for Stereotactic Body Radiotherapy in Lung Metastases.

Lung metastases are the second most common malignant neoplasms of the lung. It is estimated that 20-54% of cancer patients have lung metastases at some point during their disease course, and at least 50% of cancer-related deaths occur at this stage. Lung metastases are widely accepted to be oligometastatic when five lesions or less occur separately in up to three organs. Stereotactic body radiation therapy (SBRT) is a noninvasive, safe, and effective treatment for metastatic lung disease in carefully selected patients. There is no current consensus on the ideal dose and fractionation for SBRT in lung metastases, and it is the subject of study in ongoing clinical trials, which examines different locations in the lung (central and peripheral). This review discusses current indications, fractionations, challenges, and technical requirements for lung SBRT.

Quantum control operations with fuzzy evolution trajectories based on polyharmonic magnetic fields.

We explore a class of quantum control operations based on a wide family of harmonic magnetic fields that vary softly in time. Depending on the magnetic field amplitudes taking part, these control operations can produce either squeezing or loop (orbit) effects, and even parametric resonances, on the canonical variables. For these purposes we focus our attention on the evolution of observables whose dynamical picture is ascribed to a quadratic Hamiltonian that depends explicitly on time. In the first part of this work we survey such operations in terms of biharmonic magnetic fields. The dynamical analysis is simplified using a stability diagram in the amplitude space, where the points of each region will characterise a specific control operation. We discuss how the evolution loop effects are formed by fuzzy (non-commutative) trajectories that can be closed or open, in the latter case, even hiding some features that can be used to manipulate the operational time. In the second part, we generalise the case of biharmonic fields and translate the discussion to the case of polyharmonic fields. Using elementary properties of the Toeplitz matrices, we can derive exact solutions of the problem in a symmetric evolution interval, leading to the temporal profile of those magnetic fields suitable to achieve specific control operations. Some of the resulting fuzzy orbits can be destroyed by the influence of external forces, while others simply remain stable.

Generalized Fokker-Planck equations derived from nonextensive entropies asymptotically equivalent to Boltzmann-Gibbs.

We derive generalized Fokker-Planck equations (FPEs) based on two nonextensive entropy measures S_{±} that depend exclusively on the probability. These entropies have been originally obtained from the superstatistics framework, therefore they regard nonequilibrium systems outlined by a long-term stationary state in view of a spatiotemporally fluctuating intensive quantity. Moreover, entropies S_{±} as well as Boltzmann-Gibbs (BG) entropy S_{B} both pertain to the same asymptotical equivalence class, thus suggesting that S_{±} could depict a consistent thermodynamic generalization of BG. For these reasons, we assert that transport phenomena to be accounted for by our models shall coincide with the portrait given by the conventional FPEs for systems comprehending short-range interactions or a high number of accessible microstates, whereas, for systems composed of a small number of microstates, or those with long-range interactions, the governing equations of motion are to be the FPEs here derived, as long as the system fulfills the attributes mentioned above. We discuss the anomalous diffusion exhibited by the two generalized FPEs and also present some numerical applications. In particular, we find that there are models regarding biological sciences, for the study of congregation and aggregation behavior, the structure of which coincides with the one of our models.

A non-randomized pilot study to test the feasibility of treating chronic pain and opioid prescription use in rural areas with acceptance and commitment therapy (T-PACT).

Chronic non-cancer pain (CNCP) involves one-third of the US population, and prescription opioids contribute to the opioid epidemic. The Centers for Disease Control and Prevention emphasizes maximizing non-opioid treatment, but many rural populations cannot access alternative therapies. Clinical and Translational Science Award hubs across four rural states performed a multi-site, single-arm intervention feasibility study testing methods and procedures of implementing a behavioral intervention, acceptance and commitment therapy, in primary care CNCP patients on chronic opioids. Using the CONSORT extension for feasibility studies, we describe lessons learned in recruiting/retaining participants, intervention implementation, data measurement, and multi-site procedures. Results inform a future definitive trial and potentially others conducting rural trials.

Evaluation of Medicare's Intensive Behavioral Therapy for Obesity: the BieneStar Experience.

INTRODUCTION: In 2011, the Centers for Medicare and Medicaid Services began to reimburse primary care providers for intensive behavior therapy for obesity. This study evaluated a Centers for Medicare and Medicaid Services intensive behavior therapy for obesity program as implemented in primary care clinics. METHODS: Data for this retrospective cohort study were obtained between May 2012 and February 2015 and statistical analysis was performed in 2017. The sample included 643 participants who attended at least one BieneStar intensive behavior therapy for obesity program session. The primary outcome was weight, and covariates were number of sessions, age, race/ethnicity, diagnosis of hypertension and diabetes, and type of health insurance. RESULTS: Of 643 participants that initiated the BieneStar program, 641 had complete data. The median reduction in weight of participants was as follows: those who attended fewer than four sessions, 0 kg (95% CI=0, 0.11 kg); between four and eight sessions, 1.1 kg (95% CI=0.86, 1.59 kg); and more than eight sessions 3.7 kg (95% CI=3.36, 4.55 kg). Medians of weight were significantly different between each classification of session numbers (p<0.01). Participants lost on average 0.102 kg of weight per session attended. CONCLUSIONS: The BieneStar program showed that the weight of participants decreased as they attended more sessions. Further studies are needed to determine if these results can be reproduced in other office-based primary care clinics and the program's impact on chronic disease.

Aplasia eritroide pura: síndrome de Diamond-Blackfan / Pure erythroid aplasia: Diamond-Blackfan Syndrome

Se describe un caso de Aplasia Eritroide Pura en un lactante menor de 6 meses de edad, sexo masculino, quien presentaba palidez cutáneo-mucosa generalizada progresivae inapetencia. No se apreciaron anomalias congénitas. En la biopsia madular se apreció depresión de la serie eritrocítica. Las otras series medulares se conservaban normales. Se revisa la literatura al respecto discutiendo las caracteristicas clínicas de la enfermedad así como el tratamiento de la misma