ABSTRACT
The National Psoriasis Foundation surveyed a random, stratified sample of individuals with psoriatic disease in the United States to determine the prevalence of an unacceptable psoriatic arthritis (PsA) symptom state and its effect on depression and social participation. Acceptable and unacceptable levels of PsA were defined using established cutoff points (acceptable ≤4 vs unacceptable >4) on the Psoriatic Arthritis Impact of Disease 9. Psoriasis severity was defined by body surface area: mild < 3%, moderate-severe ≥ 3%. Depression was assessed utilizing the Patient Health Questionnaire 2. Social participation was assessed by the Patient Reported Outcome Information Measurement System Ability to Participate in Social Role and Activities-SF4a. The analysis cohort comprised 801 patients with PsA. Unacceptable disease activity level (Psoriatic Arthritis Impact of Disease >4) was reported by 59.6% of participants. After adjusting for age, sex, and psoriasis severity, individuals with likely depression (OR = 0.014, P < .001) and those with limited ability to participate in social roles and activities (OR = 0.05, P < .001) were less likely to experience acceptable levels of PsA activity. Ultimately, the results demonstrated that most United States patients with PsA have unacceptable levels of disease activity, which is associated with increased prevalence of depression and limitations in social participation.
ABSTRACT
BACKGROUND: Atrial fibrillation and atrial flutter represent the most prevalent clinically significant cardiac arrhythmias. While the CHA2DS2-VASc score is commonly used to inform anticoagulation therapy decisions for patients with these conditions, its predictive power is limited. Therefore, we sought to improve risk prediction for left atrial appendage thrombus (LAAT), a known risk factor for stroke in these patients. METHODS: We developed and validated an explainable machine learning model using the eXtreme Gradient Boosting algorithm with 5 × 5 nested cross-validation. The primary outcome was to predict the probability of LAAT in patients with atrial fibrillation and atrial flutter who underwent transesophageal echocardiogram prior to cardioversion. Our algorithm used 37 demographic, comorbid, and transthoracic echocardiographic variables. RESULTS: A total of 795 patients were included in our analysis. LAAT was present in 11.3% of the patients. The average age of patients was 63.3 years and 34.7% were women. Patients with LAAT had significantly lower left ventricular ejection fraction (29.9% vs 43.5%; p < 0.001), lower E' lateral velocity (5.7 cm vs. 7.9 cm; p < 0.001) and higher E/A ratio (2.6 vs 1.8; p = 0.002). Our machine learning model achieved a high AUC of 0.79, with a high specificity of 0.82, and modest sensitivity of 0.57. Left ventricular ejection fraction was the most important variable in predicting LAAT. Patients were split into 10 buckets based on the percentile of their predicted probability of having thrombus. The lower the percentile (e.g., 10%), the lower the probability of having thrombus. Using a cutoff point of 0.16 which includes 10.0% of the patients, we can rule out thrombus with 100% confidence. CONCLUSION: Using machine learning, we refined the predictive power of predicting LAAT and explained the model. These results show promise in providing better guidance for anticoagulation therapy and cardioversion in AF and AFL patients.
ABSTRACT
INTRODUCTION: Ineffective erythropoiesis and subsequent anemia as well as primary and secondary (transfusional) iron overload are key drivers for morbidity and mortality outcomes in patients with ß-thalassemia. AREAS COVERED: In this review, we highlight evidence from observational studies evaluating the association between measures of anemia and iron overload versus outcomes in both non-transfusion-dependent and transfusion-dependent forms of ß-thalassemia. EXPERT OPINION: Several prognostic thresholds have been identified with implications for patient management. These have also formed the basis for the design of novel therapy clinical trials by informing eligibility and target endpoints. Still, several data gaps persist in view of the challenge of assessing prospective long-term outcomes in a chronic disease. Pooling insights on the prognostic value of different measures of disease mechanism will be key to design future scoring systems that can help optimize patient management.
Subject(s)
Anemia , Biomarkers , Iron Overload , beta-Thalassemia , beta-Thalassemia/complications , beta-Thalassemia/therapy , beta-Thalassemia/diagnosis , beta-Thalassemia/mortality , beta-Thalassemia/blood , Humans , Iron Overload/etiology , Iron Overload/diagnosis , Prognosis , Anemia/etiology , Anemia/diagnosis , Anemia/therapy , Anemia/blood , Blood TransfusionABSTRACT
Background: Several endodontic difficulty assessment forms are available to help dental students and general dentists estimate the difficulty of the case before initiating the endodontic treatment. Objectives: This study aimed to assess if the American Association of Endodontics (AAE) case difficulty assessment form affects the dental student's perception of the difficulty encountered while performing root canal treatment (RCT). Materials and Methods: This was a cross-sectional online survey. After obtaining IRB approval, an electronic questionnaire was sent to dental students enrolled in the 4th and 5th years at King Saud University (KSU) and King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia. The questionnaire was divided into informed consent, demographic data, the use of the AAE case assessment form, RCT steps, diagnosis, local anesthesia administration, tooth isolation, and endodontic procedure. Results: A total of 195 dental students participated in the study. There were 101 (52%) females, and 139 (71%) were from KSAU-HS. A positive association was found between students who used the AAE assessment form and who did not with their ability to reach the correct diagnosis (p=0.005), tooth isolation (p=0.03), and endodontic procedure difficulty score (p=0.018). Conclusion: The use of the AAE form by dental students enabled them to differentiate between complicated and uncomplicated cases, thus lowering the difficulty encountered during RCT.
ABSTRACT
Introduction: This study aims to explore the predictive roles of echocardiographic parameters and biomarkers in determining outcomes among hospitalized COVID-19 patients experiencing cardiovascular events. Methods: A retrospective cohort study was conducted involving 49 COVID-19 patients who encountered cardiovascular events during hospitalization and underwent echocardiography. Our findings revealed notable associations between echocardiographic parameters and survival time. Results: A decrease in left ventricular ejection fraction (LVEF) of 10% was linked to a 20% reduction in survival time (TR: 0.80, 95% CI: 0.67 - 0.96, p = .017). Similarly, an increase in left ventricular (LV) volume by 10 mL was associated with a 9% decrease in survival time (TR: 0.91, 95% CI: 0.84 - 0.98, p = .011). Moreover, an increase in left atrial (LA) volume by 10 mL corresponded to an 8% decrease in survival time (TR: 0.92, 95% CI: 0.86 - 0.99, p = .026). Additionally, each 1 cm increase in right ventricular (RV) diameter was linked to a 22% reduction in survival time (TR: 0.78, 95% CI: 0.61 - 0.99, p = .043). Furthermore, a 10 mL increase in right atrial (RA) volume was associated with a 12% decrease in survival time (TR: 0.88, 95% CI: 0.78 - 0.98, p = .017). Notably, a tenfold rise in troponin levels was linked to a 33% decrease in survival time (TR: 0.67, 95% CI: 0.48 - 0.93, p = .014). Conclusions: Our study emphasizes the significant associations between various echocardiographic parameters and troponin levels with reduced survival time among COVID-19 patients experiencing cardiovascular events. These findings highlight the potential utility of echocardiography and troponin assessment in predicting outcomes and guiding management strategies in this patient population.
ABSTRACT
The periodontium comprising periodontal ligament (PDL), gingiva, and epithelium play crucial roles in maintaining tooth integrity and function. Understanding tissue cellular composition and gene expression is crucial for illuminating periodontal pathophysiology. This study aimed to identify tissue-specific markers via scRNA-Seq. Primary human PDL, gingiva, and epithelium tissues (n = 7) were subjected to cell hashing and sorting. scRNA-Seq library preparation using 10× Genomics protocol and Illumina sequencing was conducted. The analysis was performed using Cellranger (v3.1.0), with downstream analysis via R packages Seurat (v5.0.1) and SCORPIUS (v1.0.9). Investigations identified eight distinct cellular clusters, revealing the ubiquitous presence of epithelial and gingival cells. PDL cells evolved in two clusters with numerical superiority. The other clusters showed varied predominance regarding gingival and epithelial cells or an equitable distribution of both. The cluster harboring most cells mainly consisted of PDL cells and was present in all donors. Some of the other clusters were also tissue-inherent, while the presence of others was environmentally influenced, revealing variability across donors. Two clusters exhibited genetic profiles associated with tissue development and cellular integrity, respectively, while all other clusters were distinguished by genes characteristic of immune responses. Developmental trajectory analysis uncovered that PDL cells may develop after epithelial and gingival cells, suggesting the inherent PDL cell-dominated cluster as a final developmental stage. This single-cell RNA sequencing study delineates the hierarchical organization of periodontal tissue development, identifies tissue-specific markers, and reveals the influence of environmental factors on cellular composition, advancing our understanding of periodontal biology and offering potential insights for therapeutic interventions.
Subject(s)
Gingiva , Periodontal Ligament , Single-Cell Analysis , Transcriptome , Humans , Periodontal Ligament/metabolism , Periodontal Ligament/cytology , Gingiva/metabolism , Single-Cell Analysis/methods , Sequence Analysis, RNA/methods , Gene Expression Profiling , Epithelium/metabolism , Epithelial Cells/metabolism , Female , MaleABSTRACT
In this review, we provide a summary of evidence on iron overload in young children with transfusion-dependent ß-thalassemia (TDT) and explore the ideal timing for intervention. Key data from clinical trials and observational studies of the three available iron chelators deferoxamine, deferiprone, and deferasirox are also evaluated for inclusion of subsets of young children, especially those less than 6 years of age. Evidence on the efficacy and safety of iron chelation therapy for children ≥2 years of age with transfusional iron overload is widely available. New data exploring the risks and benefits of early-start iron chelation in younger patients with minimal iron overload are also emerging.
Subject(s)
Blood Transfusion , Chelation Therapy , Iron Chelating Agents , Iron Overload , beta-Thalassemia , Humans , beta-Thalassemia/therapy , beta-Thalassemia/drug therapy , beta-Thalassemia/complications , Iron Chelating Agents/therapeutic use , Child , Iron Overload/drug therapy , Iron Overload/etiology , Chelation Therapy/methods , Child, Preschool , Deferoxamine/therapeutic use , Deferiprone/therapeutic use , Pyridones/therapeutic use , Pyridones/adverse effectsABSTRACT
Background: The effects of SARS-CoV-2 have varied between significant waves of hospitalization. Research question: Are cardiovascular complications different among the first, delta and omicron waves of hospitalized COVID-19 pneumonia patients? Study design and methods: This was a multi-centre retrospective study of patients hospitalized with SARS-CoV-2 pneumonia: 632 were hospitalized during the first wave (March-July 2020), 1013 during the delta wave (September 2020-March 2021), and 323 during the omicron wave (January 2022-July 2022). Patients were stratified by wave and occurrence of cardiovascular events. Results: Among all hospitalized patients with cardiovascular events, patients in the omicron wave were younger (62.4 ± 14 years) than patients in the first wave (67.4 ± 7.8 years) and the delta wave (66.9 ± 12.6 years) and had a higher proportion of non-Hispanic White people than in the first wave (78.6% vs. 61.7%). For COVID-19 patients who suffered from cardiovascular events, the omicron wave patients had significantly higher neutrophil/lymphocyte ratio, white blood cell and platelet counts when compared to the first wave. Omicron wave patients had significantly lower albumin and B-type natriuretic peptide levels (only 5.8% of the first wave and 14.6% of the delta wave) when compared to either the first wave or delta wave patients. In COVID-19 patients who suffered cardiovascular events during hospitalization, mortality rate in the omicron wave (26.8%) was significantly lower than the first wave (48.3%), time to mortality for non-survivors of COVID-19 patients who suffered cardiovascular events was significantly longer in the omicron wave (median 16 days) than in the first wave (median 10 days). Conclusions: Younger and white patients were affected with cardiovascular complications more often by the omicron variant. Despite higher neutrophil/lymphocyte ratio and WBC counts, the omicron patients with cardiovascular events showed lower heart injuries, lower mortality and longer time to mortality for non-survivors when compared to the first and delta waves.
ABSTRACT
The periodontal ligament (PDL) is a highly specialized fibrous tissue comprising heterogeneous cell populations of an intricate nature. These complexities, along with challenges due to cell culture, impede a comprehensive understanding of periodontal pathophysiology. This study aims to address this gap, employing single-cell RNA sequencing (scRNA-seq) technology to analyze the genetic intricacies of PDL both in vivo and in vitro. Primary human PDL samples (n = 7) were split for direct in vivo analysis and cell culture under serum-containing and serum-free conditions. Cell hashing and sorting, scRNA-seq library preparation using the 10x Genomics protocol, and Illumina sequencing were conducted. Primary analysis was performed using Cellranger, with downstream analysis via the R packages Seurat and SCORPIUS. Seven distinct PDL cell clusters were identified comprising different cellular subsets, each characterized by unique genetic profiles, with some showing donor-specific patterns in representation and distribution. Formation of these cellular clusters was influenced by culture conditions, particularly serum presence. Furthermore, certain cell populations were found to be inherent to the PDL tissue, while others exhibited variability across donors. This study elucidates specific genes and cell clusters within the PDL, revealing both inherent and context-driven subpopulations. The impact of culture conditions-notably the presence of serum-on cell cluster formation highlights the critical need for refining culture protocols, as comprehending these influences can drive the creation of superior culture systems vital for advancing research in PDL biology and regenerative therapies. These discoveries not only deepen our comprehension of PDL biology but also open avenues for future investigations into uncovering underlying mechanisms.
Subject(s)
Periodontal Ligament , Adult , Female , Humans , Male , Cells, Cultured , Gene Expression Profiling/methods , Periodontal Ligament/cytology , Periodontal Ligament/metabolism , RNA-Seq/methods , Single-Cell Gene Expression Analysis/methods , TranscriptomeABSTRACT
BACKGROUND: Patients with dementia are at increased risk for adverse events following valvular surgery. Outcomes after mitral transcatheter edge-to-edge repair (TEER) for mitral regurgitation in this vulnerable population are not well understood. METHODS: We queried the National Inpatient Sample database for all hospitalizations for mitral TEER between 2016 and 2019. Patients with a validated diagnosis code for dementia were identified by ICD-10 codes and compared to a matched cohort of non-dementia patients using multivariable regression analysis. The primary outcome was in-hospital mortality. Secondary outcomes were hospital length of stay, discharge to nursing facility, total hospital charges, and in-hospital adverse events. RESULTS: 24,550 hospitalizations for mitral TEER were identified, including 880 patients (3.6 %) with dementia. Dementia was associated with higher in-hospital mortality (OR 4.31, 95 % CI 2.65 to 6.99, p < 0.001), prolonged length of hospital stay (OR 1.33, 95 % CI 1.12 to 1.57, p 0.001), higher discharge rate to nursing facility (OR 2.71, 95 % CI 2.13-3.44, p < 0.001), and higher rate of in-hospital adverse events including delirium (OR 5.88, 95 % CI 4.06 to 8.52, p < 0.001) and acute stroke (OR 8.87, 95 % CI 5.01 to 15.70, p < 0.001). CONCLUSIONS: Dementia is associated with worse post-procedural outcomes after mitral TEER. Further investigation is needed to elucidate mechanisms of poor clinical outcomes and guide shared decision-making in this vulnerable population.
ABSTRACT
This scoping review identified contemporary stigma-reduction studies across US health-care settings. Despite the significance of this problem, only 3 intervention studies were identified in the past 5 years. These studies highlight the value of intervening during formative training experiences and the importance of including interprofessional health-care providers in interventions. The findings relate to the novel approaches (eg, virtual patient simulations) that are used in interventions. The importance of using a participatory approach to intervention design is noted. Critical gaps in human immunodeficiency virus (HIV) stigma measurement and the lack of interventions are identified, laying a foundation for future programs and research.
Subject(s)
HIV Infections , Social Stigma , Humans , HIV Infections/psychology , United States , Health Personnel/psychologyABSTRACT
BACKGROUND: Long-COVID is a multisystem disease that can lead to significant impairments in health-related quality of life (HRQoL). Following COVID-19 infection, abnormalities on pulmonary function tests (PFT) are common. The primary aim of this study is to evaluate for any correlation between PFT abnormalities and impairment in HRQoL scores following COVID-19 infection. METHODS: This is an analysis of a prospective cohort of patients in Louisville, KY who were infected with COVID-19. Data collected included demographics, past medical history, laboratory tests, PFTs, and several HRQoL questionnaires such as the EuroQol 5 Dimension HRQoL questionnaire (EQ-5D-5 L), Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire (PHQ-9), and Posttraumatic stress disorder checklist for DSM-5 (PCL-5). Descriptive statistics were performed, comparing PFTs (normal vs abnormal) and time since COVID-19 infection (3- vs 6- vs ≥ 12 months). RESULTS: There were no significant differences in FEV1, FVC, or the percentage of patients with abnormal PFTs over time after COVID-19 infection. Following COVID-19, patients with normal PFTs had worse impairment in mobility HRQoL scores and change in GAD-7 scores over time. There were no differences over time in any of the HRQoL scores among patients with abnormal PFTs. CONCLUSIONS: Among patients with an abnormal PFT, there was no temporal association with HRQoL scores as measured by EQ-5D-5 L, GAD-7, PHQ-9, and PCL-5. Among patients with a normal PFT, mobility impairment and anxiety may be associated with COVID-19 infection. Following COVID-19 infection, impairment in HRQoL scores is not completely explained by the presence of abnormalities on spirometry.
Subject(s)
COVID-19 , Quality of Life , Respiratory Function Tests , Humans , COVID-19/psychology , COVID-19/physiopathology , COVID-19/epidemiology , COVID-19/complications , Male , Female , Middle Aged , Prospective Studies , Aged , Adult , Surveys and Questionnaires , SARS-CoV-2 , AnxietyABSTRACT
DNA methylation is one of the most important epigenetic mark involved in many physiologic cellular processes and pathologies. During mitosis, the transmission of DNA methylation patterns from a mother to the daughter cells is ensured through the action of the Ubiquitin-like, containing PHD and RING domains, 1/DNA methyltransferase 1 (UHRF1/DNMT1) tandem. UHRF1 is involved in the silencing of many tumor suppressor genes (TSGs) via mechanisms that remain largely to be deciphered. The present study investigated the role and the regulation of UHRF1 poly-ubiquitination induced by thymoquinone, a natural anti-cancer drug, known to enhance or re-activate the expression of TSGs. We found that the auto-ubiquitination of UHRF1, induced by TQ, is mediated by reactive oxygen species, and occurs following DNA damage. We demonstrated that the poly-ubiquitinated form of UHRF1 is K63-linked and can still silence the tumor suppressor gene p16INK4A/CDKN2A. We further showed that TQ-induced auto-ubiquitination is mediated via the activity of Tip60. Since this latter is known as a nuclear receptor co-factor, we investigated if the glucocorticoid receptor (GR) might be involved in the regulation of UHRF1 ubiquitination. Activation of the GR, with dexamethasone, did not influence auto-ubiquitination of UHRF1. However, we could observe that TQ induced a K48-linked poly-ubiquitination of GR, probably involved in the proteosomal degradation pathway. Mass-spectrometry analysis of FLAG-HA-tagged UHRF1 identified UHRF1 partners involved in DNA repair and showed that TQ increased their association with UHRF1, suggesting that poly-ubiquitination of UHRF1 is involved in the DNA repair process. We propose that poly-ubiquitination of UHRF1 serves as a scaffold to recruit the DNA repair machinery at DNA damage sites.
Subject(s)
Benzoquinones , CCAAT-Enhancer-Binding Proteins , DNA Repair , Ubiquitin-Protein Ligases , Ubiquitination , Humans , Ubiquitin-Protein Ligases/metabolism , Ubiquitin-Protein Ligases/genetics , CCAAT-Enhancer-Binding Proteins/metabolism , CCAAT-Enhancer-Binding Proteins/genetics , Ubiquitination/drug effects , Benzoquinones/pharmacology , DNA Repair/drug effects , Antineoplastic Agents/pharmacology , DNA Damage/drug effectsABSTRACT
Exome sequencing (ES) has identified biallelic kinesin family member 12 (KIF12) mutations as underlying neonatal cholestatic liver disease. We collected information on onset and progression of this entity. Among consecutively referred pediatric patients at our centers, diagnostic ES identified 4 patients with novel, biallelic KIF12 variants using the human GRCh38 reference sequence, as KIF12 remains incompletely annotated in the older reference sequence GRCh37. A review of these and of 21 reported patients with KIF12 variants found that presentation with elevated serum transaminase activity in the context of trivial respiratory infection, without clinical features of liver disease, was more common (n = 18) than manifest cholestatic disease progressing rapidly to liver transplantation (LT; n = 7). Onset of liver disease was at age <1 year in 15 patients; LT was more common in this group. Serum gamma-glutamyl transpeptidase activity (GGT) was elevated in all patients, and total bilirubin was elevated in 15 patients. Liver fibrosis or cirrhosis was present in 14 of 18 patients who were biopsied. The 16 different pathogenic variants and 11 different KIF12 genotypes found were not correlated with age of onset or progression to LT. Identification of biallelic pathogenic KIF12 variants distinguishes KIF12-related disease from other entities with elevated GGT.
Subject(s)
Kinesins , Liver Diseases , Mutation , gamma-Glutamyltransferase , Humans , Kinesins/genetics , gamma-Glutamyltransferase/blood , gamma-Glutamyltransferase/genetics , Male , Female , Liver Diseases/genetics , Liver Diseases/pathology , Infant , Exome Sequencing , Infant, Newborn , Genetic Predisposition to Disease , Liver Transplantation , Genotype , Alleles , Child, Preschool , ChildABSTRACT
BACKGROUND: Sexual changes in breast cancer occur after diagnosis and treatment, including a mastectomy. Sexual assertiveness is an effective factor in sexual satisfaction, which means the ability to convey sexual feelings, beliefs, and thoughts. Given the limited studies on sexual assertiveness in breast cancer and different client participation, this study was conducted to compare the effect of sexual counseling based on two models of PLISSIT (Permission, Limited Information, Specific Suggestion, Intensive Therapy) and BETTER (Bring Up, Explain, Tell, Time, Education, Record) on sexual assertiveness in women after mastectomy. MATERIALS AND METHODS: This quasi-experimental intervention was conducted in 2021 in Mashhad, Iran. Seventy-eight mastectomized women with breast cancer were assigned to the BETTER (n = 39) and PLISSIT (n = 39) groups using permuted block randomization with a block size of 4 and an allocation ratio of 1:1. Both groups received four individual counseling sessions, one week apart. The research tools included a demographic information form and the Hulbert index of sexual assertiveness. Changes in the mean scores of sexual assertiveness between the two groups were evaluated before and four weeks after the intervention, and the mean changes were compared between the groups. Data analysis was conducted using the Kolmogorov-Smirnov test, independent t-test, paired t-test, and Chi-square tests using Statistical Package for the Social Sciences (SPSS) version 25 (P < 0.05). RESULTS: The results of the study showed that before the intervention, there was no significant difference in the score of sexual assertiveness in both groups (P = 0.253). The mean score of sexual assertiveness changes before and after the intervention in the BETTER group (8.07 ± 4.9) was significantly higher than in the PLISSIT group (5.58 ± 4.7) (P < 0.001). CONCLUSION: The results indicated that BETTER sexual counseling was more effective in increasing the sexual assertiveness of mastectomized women than PLISSIT counseling. Due to its simplicity and client-centeredness, this model can be used in breast cancer care programs.
ABSTRACT
Interactions between law enforcement agents in conservation (e.g., rangers) and illegal resource users (e.g., illegal hunters) can be violent and sometimes fatal, which negatively affects conservation efforts and people's well-being. Models from social psychology, such as integrated threat theory (ITT) (intergroup interactions shape intergroup emotions, prejudices and perceived threats leading to hostile attitudes or behaviors between groups), are useful in addressing such interactions. Conservation approaches relying mainly on law enforcement have never been investigated using this framework. Using a structured questionnaire, we collected data from 282 rangers in protected and unprotected areas (n = 50) in northern Iran. We applied Bayesian structural equation modeling in an assessment of rangers' affective attitudes (i.e., emotions or feelings that shape attitudes toward a person or object) toward illegal hunters in an ITT framework. Rangers' positive perceptions of illegal hunters were negatively associated with intergroup anxiety (emotional response to fear) and negative stereotypes about a hunter's personality, which mediated the relationship between negative contact and affective attitudes. This suggests that negative contact, such as verbal abuse, may lead rangers to perceive illegal hunters as arrogant or cruel, which likely forms a basis for perceived threats. Rangers' positive contact with illegal hunters, such as playing or working together, likely lowered their perceived realistic threats (i.e., fear of property damage). Perceived realistic threats of rangers were positively associated with negative contacts (e.g., physical harm). The associations we identified suggest that relationships based on positive interactions between rangers and illegal hunters can reduce fear and prejudice. Thus, we suggest that rangers and hunters be provided with safe spaces to have positive interactions, which may help lower tension and develop cooperative conservation mechanisms.
Aplicación de la teoría integrada de la amenaza a la implementación de las leyes de conservación Resumen Las interacciones entre los agentes de la ley de la conservación (p. ej.: guardabosques) y los usuarios ilegales de recursos (p. ej.: cazadores ilegales) pueden ser violentas y a veces fatales, lo que afecta negativamente los esfuerzos de conservación y el bienestar de las personas. Los modelos de la psicología social, como la teoría integrada de la amenaza (TIA) (una amenaza percibida que deriva en prejuicios entre los grupos), tienen un uso potencial para tratar estas interacciones. Nunca se ha usado este marco para investigar las estrategias de conservación que dependen principalmente de la implementación de la ley. Usamos un cuestionario estructurado para recolectar datos de 282 guardabosques en áreas protegidas y no protegidas (n = 50) en el norte de Irán. Aplicamos el modelo de ecuación estructural bayesiano a la evaluación de las actitudes afectivas que tienen los guardabosques (es decir, emociones o sentimientos que forjan la actitud hacia una persona o un objeto) hacia los cazadores ilegales en un marco de TIA. La percepción negativa que tienen los guardabosques de los cazadores ilegales estuvo asociada negativamente con ansiedad intergrupal (la respuesta emocional al miedo) y estereotipos negativos de la personalidad de los cazadores, las cuales mediaron la relación entre el contacto negativo y las actitudes afectivas. Esto sugiere que el contacto negativo, como el abuso verbal, puede causar que los guardabosques perciban a los cazadores ilegales como arrogantes o crueles, lo que probablemente forma una base para las amenazas percibidas. El contacto positivo entre los guardabosques y los cazadores ilegales, como jugar o trabajar juntos, probablemente disminuyó la percepción de las amenazas realistas (es decir, miedo al daño material). La percepción que tienen los guardabosques de las amenazas realistas estuvieron asociadas positivamente con los contactos negativos (p. ej.: daño físico). Las asociaciones que identificamos sugieren que las relaciones basadas en las interacciones positivas entre los guardabosques y los cazadores ilegales pueden reducir el miedo y los prejuicios. Por lo tanto, sugerimos que se les proporcionen espacios seguros a los guardabosques y a los cazadores ilegales para que puedan tener interacciones positivas, lo que podría ayudar a reducir tensiones y a desarrollar mecanismos cooperativos de conservación.
Subject(s)
Attitude , Conservation of Natural Resources , Law Enforcement , Humans , Iran , Bayes Theorem , Surveys and QuestionnairesABSTRACT
Introduction Gallbladder disease accounts for a significant percentage of surgical admissions per year. A review of these cases was done to assess their hospital impact with an evaluation of the efficacy of radiological modalities in terms of evaluation, ideal use, and clinical application. Therefore, this study aims to review the demographics of the disease, the diagnostic yield of radiological modalities, and the overall outcome in regards to the hospital policies and medical services provided in hopes of achieving suitable clinical pathways, increasing the efficiency of gallbladder disease assessment, and limiting unwarranted investigations. Methods This is a single-center, retrospective study that included all the surgical emergency admissions from January 1st to December 31st 2018, in the Salmaniya Medical Complex, Kingdom of Bahrain. A total sample of 163 emergency admissions (cases) was selected from those aged 14 and older with documented biliary stones or biliary-related disease. A review of radiological modalities for diagnosis included plain radiographs (AXR, CXR), US abdomen, CT scans, and MRCP/MRI, which were then correlated with histopathological findings confirming the presence of gallstone disease. In addition to evaluating readmissions and emergency visits in terms of hospital burden. Results One hundred and sixty-three (10.44%) of 1,562 surgical admission cases in 2018 were diagnosed with biliary tree disease (76 males, 87 females). A total of 419 different radiological investigations were requested in 161 of the cases evaluated: 53.7% of plain radiographs (AXR, CXR), 33.2% of US abdomen, 11.9% of CT scan, and 1.2% of MRCP/MRI. Ultrasound showed a sensitivity of 48.72% and a specificity of 100%, while CT scan sensitivity was 57.14% and a specificity of 100% when it came to detecting gallstones and gallbladder-related disease. Plain radiographs add no direct benefit to diagnosing biliary disease. Conclusion Gallbladder disease is very prevalent with a wide array of disease entities, requiring radiological assistance in diagnosis. Ultrasound is the ideal modality for the diagnosis of biliary disease due to its ease of use and availability; it has high sensitivity and specificity, and it can be complemented by other modalities such as CT scans and MRCP/MRI when it comes to assessing for complications. On the other hand, plain radiographs have no significant value in the detection of gallbladder-related disease, and their utilization should be limited to emergency cases with high clinical suspicion.
ABSTRACT
Advances in understanding the disease process in ß-thalassemia supported development of various treatment strategies that resulted in improved survival. Improved survival, however, allowed multiple morbidities to manifest and cemented the need for frequent, lifelong treatment. This has directly impacted patients' health-related quality of life and opened the door for various psychiatric and cognitive disorders to potentially develop. In this review, we summarize available evidence on quality of life, depression and anxiety, suicidality, and cognitive impairment in adult patients with ß-thalassemia while sharing our personal insights from experience in treating patients with both transfusion-dependent and non-transfusion-dependent forms.
Subject(s)
Cognitive Dysfunction , beta-Thalassemia , Adult , Humans , beta-Thalassemia/complications , beta-Thalassemia/therapy , Mood Disorders/etiology , Quality of Life/psychology , Cognitive Dysfunction/etiologyABSTRACT
AIM: To capture and retain healthcare staff in postgraduate courses relevant to individual career aspirations, service requirements and continuous practice development (CPD) within an English UK university. DESIGN: Two virtual career clinics for postgraduate practitioners to engage in CPD offers within the university. An online post-enrolment online survey to explore their experiences of engagement with the university. METHODS: Mixed: qualitative and quantitative methods. Engaging 10 participants attended the career clinics, and 42 participants with an online survey. RESULTS: The career clinics were well received by participants who mapped CPD requirements and individual career aspirations. The surveys exposed challenges with marketing and enrolment; however, these were mitigated with support. Four recommendations are presented within this paper applicable to the international postgraduate education of all health practitioners.
Subject(s)
Education, Nursing, Graduate , Health Personnel , HumansABSTRACT
HIRIP3 is a mammalian protein homologous to the yeast H2A.Z deposition chaperone Chz1. However, the structural basis underlying Chz's binding preference for H2A.Z over H2A, as well as the mechanism through which Chz1 modulates histone deposition or replacement, remains enigmatic. In this study, we aimed to characterize the function of HIRIP3 and to identify its interacting partners in HeLa cells. Our findings reveal that HIRIP3 is specifically associated in vivo with H2A-H2B dimers and CK2 kinase. While bacterially expressed HIRIP3 exhibited a similar binding affinity towards H2A and H2A.Z, the associated CK2 kinase showed a notable preference for H2A phosphorylation at serine 1. The recombinant HIRIP3 physically interacted with the H2A αC helix through an extended CHZ domain and played a crucial role in depositing the canonical core histones onto naked DNA. Our results demonstrate that mammalian HIRIP3 acts as an H2A histone chaperone, assisting in its selective phosphorylation by Ck2 kinase at serine 1 and facilitating its deposition onto chromatin.