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1.
medRxiv ; 2024 Apr 22.
Article in English | MEDLINE | ID: mdl-38712052

ABSTRACT

Background: Residential segregation has been identified as drivers of disparities in health outcomes, but further work is needed to understand this association with clinical outcomes for out-of-hospital cardiac arrest (OHCA). We utilized Cardiac Arrest Registry to Enhance Survival (CARES) dataset to examine if there are differences in survival to discharge and survival with good neurological outcome, as well as likelihood of bystander CPR, using validated measures of racial, ethnic, and economic segregation. Methods: We conducted a retrospective observational study using data from the Cardiac Arrest Registry to Enhance Survival (CARES) dataset to examine associations among adult OHCA patients. The primary predictor was the Index of Concentration at the Extremes (ICE), a validated measure that includes race, ethnicity, and income across three measures at the census tract level. The primary outcomes were survival to discharge and survival with good neurological status. A multivariable modified Poisson regression modeling approach with random effects at the EMS agency and hospital level was utilized. Results: We identified 626,264 OHCA patients during the study period. The mean age was 62 years old (SD 17.2 years), and 35.7% (n =223,839) of the patients were female. In multivariable models, we observed an increased likelihood of survival to discharge and survival with good neurological outcome for those patients residing in predominately White population census tracts and higher income census tracts as compared to lower income Black and Hispanic/Latinx population census tracts (RR 1.24, CI 1.20-1.28) and a 32% increased likelihood of receiving bystander CPR in higher income census tracts as compared to reference (RR 1.32, CI 1.30-1.34). Conclusions: In this study examining the association of measures of residential segregation and OHCA outcomes, there was an increased likelihood of survival to discharge, survival with good neurological status, and likelihood of receiving B-CPR for those patients residing in predominately White population and higher income census tracts when compared to predominately Black and/or Hispanic Latinx populations and lower income census tracts. This research suggests that areas impacted by residential and economic segregation are important targets for both public policy interventions as well as addressing disparities in care across the chain of survival for OHCA.

2.
Article in English | MEDLINE | ID: mdl-38722280

ABSTRACT

KEY POINTS: The angled tip and small size of the crescent blade provide versatility for its use in a variety of endonasal procedures. The crescent blade enables cutting along 180° from the tip, ensuring a tangential cut through the mucosa, which is important for flap viability. The disposable nature of the blade ensures that it is always sharp, allowing for its use in mucosal and cartilaginous cuts.

3.
Article in English | MEDLINE | ID: mdl-38763835

ABSTRACT

OBJECTIVE: Anxiety disorders and subsyndromal anxiety symptoms are highly prevalent in late life. Recent studies support that anxiety may be a neuropsychiatric symptom during preclinical Alzheimer's disease (AD) and that higher anxiety is associated with more rapid cognitive decline and progression to cognitive impairment. However, the associations of specific anxiety symptoms with AD pathologies and with co-occurring subjective and objective cognitive changes have not yet been established. METHODS: Baseline data from the A4 and Longitudinal Evaluation of Amyloid Risk and Neurodegeneration studies were analyzed. Older adult participants (n = 4,486) underwent assessments of anxiety (State-Trait Anxiety Inventory-6 item version [STAI]), and cerebral amyloid-beta (Aß; 18F-florbetapir) PET and a subset underwent tau (18F-flortaucipir) PET. Linear regressions estimated associations of Aß in a cortical composite and tau in the amygdala, entorhinal, and inferior temporal regions with STAI-Total and individual STAI item scores. Models adjusted for age, sex, education, marital status, depression, Apolipoprotein ε4 genotype, and subjective and objective cognition (Cognitive Function Index-participant; Preclinical Alzheimer Cognitive Composite). RESULTS: Greater Aß deposition was significantly associated with higher STAI-Worry, adjusting for all covariates, but not with other STAI items or STAI-Total scores. In mediation analyses, the association of Aß with STAI-Worry was partially mediated by subjective cognition with a stronger direct effect. No associations were found for regional tau deposition with STAI-Total or STAI-Worry score. CONCLUSION: Greater worry was associated with Aß but not tau deposition, independent of subjective and objective cognition in cognitively unimpaired (CU) older adults. These findings implicate worry as an early, specific behavioral marker and a possible therapeutic target in preclinical AD.

4.
Sci Total Environ ; 934: 173216, 2024 May 21.
Article in English | MEDLINE | ID: mdl-38776785

ABSTRACT

Information about impacts of long-term biosolids application on soil microbial populations and functional groups and N cycling is important for evaluating soil health and agroecosystem sustainability under long-term biosolids application. Mine spoil plots received annual biosolids application from 1973 to 2010 at low (16.8 Mg ha-1 yr-1), medium (33.6 Mg ha-1 yr-1), and high rates (67.2 Mg ha-1 yr-1). A no-biosolids control received chemical fertilizer at the agronomic rate. Soil samples were collected in three seasons per year spanning 2003-2005 for measuring soil moisture, pH, soil organic C (SOC), total and extractable heavy metals (Cd, Cu, Ni, Zn), NO3-, N mineralization potential (NMP), microbial biomass C (MBC), and populations of three N-cycling bacteria (NCB) groups: ammonia-oxidizing bacteria (AOB), nitrite-oxidizing bacteria (NOB), and denitrifying bacteria (DNB). Soil samples were collected again in 2008 and 2010 for quantifying total and extractable heavy metals, and in 2018 (eight years after biosolids applications ended) for measuring SOC, MBC, NMP, and microbial respiration. During 2003-2005, mean MBC was 315, 554, 794, and 1001 mg kg-1 in the control, low, medium, and high biosolids treatments, respectively. Populations of NCB did not differ among treatments. Biosolids application increased total and extractable metal concentrations but the effect of biosolids rates were much lower on extractable than total concentrations. Soil extractable Cd and Cu concentrations decreased from medium to high applications, likely due to complexing with biosolids organic matter. Partial least squares regression analysis identified a strong positive effect on MBC of SOC and a weak negative effect of Cu, explaining the strong net positive effect of biosolids on MBC. In 2018, the medium and high biosolids treatments maintained higher SOC, MBC, NMP, and microbial respiration than the control. This study provided further evidence that long-term biosolids application has positive effects on soil microbes that persist for years after ending application.

5.
Article in English | MEDLINE | ID: mdl-38700538

ABSTRACT

OBJECTIVE: Identifying the biomarkers for uncontrolled chronic rhinosinusitis (CRS) is important for directing treatment decisions. Eosinophilia has been reported to be involved in the poor disease control of CRS and mucus eosinophil-derived neurotoxin (EDN) is potentially a biomarker of intense eosinophil activation. This study aimed to assess the relationship between mucus EDN levels, disease severity, and degree of CRS control. METHODS: A total of 150 adult patients with CRS and 25 healthy controls were prospectively enrolled. The nasal mucus and tissue specimens were collected to analyze EDN levels. Disease severity was assessed by Lund-Mackay score and 22-item Sino-Nasal Outcome Test (SNOT-22) score. Five CRS symptom severities during the prior month (nasal blockage, rhinorrhoea/postnasal drip, facial pain/pressure, smell, sleep disturbance or fatigue), use of rescue medications in the last six months, and the presence of diseased mucosa on nasal endoscopy were obtained. Consistent with the European Position Paper on Rhinosinusitis and Nasal Polyps 2020 CRS control criteria, uncontrolled CRS was defined as meeting at least three items. RESULTS: 40% of patients with CRS presented with uncontrolled status. Patients with uncontrolled CRS had significantly higher nasal mucus EDN levels (P = 0.010), percentage of blood eosinophil (P = 0.015), SNOT-22 score (P < 0.001), Lund-Mackay score (P = 0.008), and a more eosinophilic dominant phenotype of CRS (P < 0.001) than patients with controlled CRS. Furthermore, mucus EDN levels were positively correlated with blood eosinophils (r = 0.541, P = 0.005), SNOT-22 score (r = 0.460, P = 0.021), and Lund-Mackay score (r = 0.387, P = 0.039). Mucus EDN levels were the significant parameter related to uncontrolled CRS in multivariable analysis after adjusting for patient demographics and comorbidities (odds ratio = 1.323; P = 0.004). CONCLUSIONS: Mucus EDN levels may be a potential biomarker for identifying the CRS control status.

6.
J Alzheimers Dis ; 99(2): 493-501, 2024.
Article in English | MEDLINE | ID: mdl-38701141

ABSTRACT

Background: The prevalence of Alzheimer's disease and related disorders (ADRD) is rising. Primary care providers (PCPs) will increasingly be required to play a role in its detection but lack the training to do so. Objective: To develop a model for cognitive evaluation which is feasible in primary care and evaluate its implementation in a large health system. Methods: The Cognition in Primary Care Program consists of web-based training together with integrated tools built into the electronic record. We implemented the program among PCPs at 14 clinics in a large health system. We (1) surveyed PCPs to assess the impact of training on their confidence to evaluate cognition, (2) measured the number of cognitive assessments they performed, and (3) tracked the number of patients diagnosed with mild cognitive impairment (MCI). Results: Thirty-nine PCPs completed the training which covered how to evaluate cognition. Survey response rate from those PCPs was 74%. Six months after the end of the training, they reported confidence in assessing cognition (mean 4.6 on 5-point scale). Cognitive assessments documented in the health record increased from 0.8 per month before the training to 2.5 in the six months after the training. Patients who were newly diagnosed with MCI increased from 4.2 per month before the training to 6.0 per month in the six months after the training. Conclusions: This model for cognitive evaluation in a large health system was shown to increase cognitive testing and increase diagnoses of MCI. Such improvements are essential for the timely detection of ADRD.


Subject(s)
Cognitive Dysfunction , Primary Health Care , Humans , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/epidemiology , Male , Female , Neuropsychological Tests , Aged
7.
PLoS One ; 19(5): e0302653, 2024.
Article in English | MEDLINE | ID: mdl-38748750

ABSTRACT

Out-of-hospital cardiac arrest (OHCA) affects over 360,000 adults in the United States each year with a 50-80% mortality prior to reaching medical care. Despite aggressive supportive care and targeted temperature management (TTM), half of adults do not live to hospital discharge and nearly one-third of survivors have significant neurologic injury. The current treatment approach following cardiac arrest resuscitation consists primarily of supportive care and possible TTM. While these current treatments are commonly used, mortality remains high, and survivors often develop lasting neurologic and cardiac sequela well after resuscitation. Hence, there is a critical need for further therapeutic development of adjunctive therapies. While select therapeutics have been experimentally investigated, one promising agent that has shown benefit is CO. While CO has traditionally been thought of as a cellular poison, there is both experimental and clinical evidence that demonstrate benefit and safety in ischemia with lower doses related to improved cardiac/neurologic outcomes. While CO is well known for its poisonous effects, CO is a generated physiologically in cells through the breakdown of heme oxygenase (HO) enzymes and has potent antioxidant and anti-inflammatory activities. While CO has been studied in myocardial infarction itself, the role of CO in cardiac arrest and post-arrest care as a therapeutic is less defined. Currently, the standard of care for post-arrest patients consists primarily of supportive care and TTM. Despite current standard of care, the neurological prognosis following cardiac arrest and return of spontaneous circulation (ROSC) remains poor with patients often left with severe disability due to brain injury primarily affecting the cortex and hippocampus. Thus, investigations of novel therapies to mitigate post-arrest injury are clearly warranted. The primary objective of this proposed study is to combine our expertise in swine models of CO and cardiac arrest for future investigations on the cellular protective effects of low dose CO. We will combine our innovative multi-modal diagnostic platform to assess cerebral metabolism and changes in mitochondrial function in swine that undergo cardiac arrest with therapeutic application of CO.


Subject(s)
Carbon Monoxide , Disease Models, Animal , Animals , Swine , Carbon Monoxide/pharmacology , Carbon Monoxide/metabolism , Heart Arrest/therapy , Out-of-Hospital Cardiac Arrest/therapy , Male , Cardiopulmonary Resuscitation/methods
8.
medRxiv ; 2024 Apr 19.
Article in English | MEDLINE | ID: mdl-38699362

ABSTRACT

Importance: Infant alertness and neurologic changes are assessed by exam, which can be intermittent and subjective. Reliable, continuous methods are needed. Objective: We hypothesized that our computer vision method to track movement, pose AI, could predict neurologic changes. Design: Retrospective observational study from 2021-2022. Setting: A level four urban neonatal intensive care unit (NICU). Participants: Infants with corrected age ≤1 year, comprising 115 patients with 4,705 hours of video data linked to electroencephalograms (EEG), including 46% female and 25.2% white non-Hispanic. Exposures: Pose AI prediction of anatomic landmark position and an XGBoost classifier trained on one-minute variance in pose. Main outcomes and measures: Outcomes were cerebral dysfunction, diagnosed from EEG readings by an epileptologist, and sedation, defined by the administration of sedative medications. Measures of algorithm performance were receiver operating characteristic-area under the curves (ROC-AUCs) on cross-validation and on two test datasets comprised of held-out infants and held-out video frames from infants used in training. Results: Infant pose was accurately predicted in cross-validation, held-out frames, and held-out infants (respective ROC-AUCs 0.94, 0.83, 0.89). Median movement increased with age and, after accounting for age, was lower with sedative medications and in infants with cerebral dysfunction (all P<5×10-3, 10,000 permutations). Sedation prediction had high performance on cross-validation, held-out frames, and held-out infants (ROC-AUCs 0.90, 0.91, 0.87), as did prediction of cerebral dysfunction (ROC-AUCs 0.91, 0.90, 0.76). Conclusions and Relevance: We used pose AI to predict sedation and cerebral dysfunction in 4,705 hours of video from a large, diverse cohort of infants. Pose AI may offer a scalable, minimally invasive method for neuro-telemetry in the NICU.

9.
Membranes (Basel) ; 14(5)2024 May 13.
Article in English | MEDLINE | ID: mdl-38786944

ABSTRACT

The production of pure water plays a pivotal role in enabling sustainable green hydrogen production through electrolysis. The current industrial approach for generating pure water relies on energy-intensive techniques such as reverse osmosis. This study unveils a straightforward method to produce pure water, employing real-world units derived from previously simulated and developed laboratory devices. This demonstrated system is cost-effective and boasts low energy consumption, utilizing membrane distillation (MD) driven by the waste heat harnessed from photovoltaic (PV) panels. In a previous study, modeling simulations were conducted to optimize the multi-layered MD system, serving as a blueprint for the construction of prototype devices with a suitable selection of materials, enabling the construction of field-testable units. The most efficient PV-MD device, featuring evaporation and condensation zones constructed from steel sheets and polytetrafluoroethylene (PTFE) membranes, is capable of yielding high-purity water with conductivity levels below 145 µS with high flux rates.

10.
Article in English | MEDLINE | ID: mdl-38771093

ABSTRACT

BACKGROUND: Artificial intelligence (AI) and large language models (LLMs) can play a critical role in emergency room operations by augmenting decision-making about patient admission. However, there are no studies for LLMs using real-world data and scenarios, in comparison to and being informed by traditional supervised machine learning (ML) models. We evaluated the performance of GPT-4 for predicting patient admissions from emergency department (ED) visits. We compared performance to traditional ML models both naively and when informed by few-shot examples and/or numerical probabilities. METHODS: We conducted a retrospective study using electronic health records across 7 NYC hospitals. We trained Bio-Clinical-BERT and XGBoost (XGB) models on unstructured and structured data, respectively, and created an ensemble model reflecting ML performance. We then assessed GPT-4 capabilities in many scenarios: through Zero-shot, Few-shot with and without retrieval-augmented generation (RAG), and with and without ML numerical probabilities. RESULTS: The Ensemble ML model achieved an area under the receiver operating characteristic curve (AUC) of 0.88, an area under the precision-recall curve (AUPRC) of 0.72 and an accuracy of 82.9%. The naïve GPT-4's performance (0.79 AUC, 0.48 AUPRC, and 77.5% accuracy) showed substantial improvement when given limited, relevant data to learn from (ie, RAG) and underlying ML probabilities (0.87 AUC, 0.71 AUPRC, and 83.1% accuracy). Interestingly, RAG alone boosted performance to near peak levels (0.82 AUC, 0.56 AUPRC, and 81.3% accuracy). CONCLUSIONS: The naïve LLM had limited performance but showed significant improvement in predicting ED admissions when supplemented with real-world examples to learn from, particularly through RAG, and/or numerical probabilities from traditional ML models. Its peak performance, although slightly lower than the pure ML model, is noteworthy given its potential for providing reasoning behind predictions. Further refinement of LLMs with real-world data is necessary for successful integration as decision-support tools in care settings.

11.
Nanophotonics ; 13(10): 1735-1743, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38681679

ABSTRACT

Design strategies for improving terahertz (THz) quantum cascade lasers (QCLs) in the 5-6 THz range are investigated numerically and experimentally, with the goal of overcoming the degradation in performance that occurs as the laser frequency approaches the Reststrahlen band. Two designs aimed at 5.4 THz were selected: one optimized for lower power dissipation and one optimized for better temperature performance. The active regions exhibited broadband gain, with the strongest modes lasing in the 5.3-5.6 THz range, but with other various modes observed ranging from 4.76 to 6.03 THz. Pulsed and continuous-wave (cw) operation is observed up to temperatures of 117 K and 68 K, respectively. In cw mode, the ridge laser has modes up to 5.71 THz - the highest reported frequency for a THz QCL in cw mode. The waveguide loss associated with the doped contact layers and metallization is identified as a critical limitation to performance above 5 THz.

12.
Clin Infect Dis ; 78(Supplement_2): S93-S100, 2024 Apr 25.
Article in English | MEDLINE | ID: mdl-38662701

ABSTRACT

BACKGROUND: Mass drug administration (MDA) is the cornerstone for the elimination of lymphatic filariasis (LF). The proportion of the population that is never treated (NT) is a crucial determinant of whether this goal is achieved within reasonable time frames. METHODS: Using 2 individual-based stochastic LF transmission models, we assess the maximum permissible level of NT for which the 1% microfilaremia (mf) prevalence threshold can be achieved (with 90% probability) within 10 years under different scenarios of annual MDA coverage, drug combination and transmission setting. RESULTS: For Anopheles-transmission settings, we find that treating 80% of the eligible population annually with ivermectin + albendazole (IA) can achieve the 1% mf prevalence threshold within 10 years of annual treatment when baseline mf prevalence is 10%, as long as NT <10%. Higher proportions of NT are acceptable when more efficacious treatment regimens are used. For Culex-transmission settings with a low (5%) baseline mf prevalence and diethylcarbamazine + albendazole (DA) or ivermectin + diethylcarbamazine + albendazole (IDA) treatment, elimination can be reached if treatment coverage among eligibles is 80% or higher. For 10% baseline mf prevalence, the target can be achieved when the annual coverage is 80% and NT ≤15%. Higher infection prevalence or levels of NT would make achieving the target more difficult. CONCLUSIONS: The proportion of people never treated in MDA programmes for LF can strongly influence the achievement of elimination and the impact of NT is greater in high transmission areas. This study provides a starting point for further development of criteria for the evaluation of NT.


Subject(s)
Albendazole , Elephantiasis, Filarial , Filaricides , Ivermectin , Mass Drug Administration , Elephantiasis, Filarial/drug therapy , Elephantiasis, Filarial/prevention & control , Elephantiasis, Filarial/epidemiology , Elephantiasis, Filarial/transmission , Humans , Animals , Filaricides/therapeutic use , Filaricides/administration & dosage , Albendazole/administration & dosage , Albendazole/therapeutic use , Ivermectin/administration & dosage , Ivermectin/therapeutic use , Prevalence , Anopheles/parasitology , Disease Eradication/methods , Wuchereria bancrofti/drug effects , Diethylcarbamazine/administration & dosage , Diethylcarbamazine/therapeutic use , Drug Therapy, Combination
13.
Membranes (Basel) ; 14(4)2024 Apr 05.
Article in English | MEDLINE | ID: mdl-38668113

ABSTRACT

In recent years, anion exchange membranes (AEMs) have aroused widespread interest in hydrogen production via water electrolysis using renewable energy sources. The two current commercial low-temperature water electrolysis technologies used are alkaline water electrolysis (AWE) and proton exchange membrane (PEM) water electrolysis. The AWE technology exhibited the advantages of high stability and increased cost-effectiveness with low hydrogen production efficiency. In contrast, PEM water electrolysis exhibited high hydrogen efficiency with low stability and cost-effectiveness, respectively. Unfortunately, the major challenges that AEMs, as well as the corresponding ion transportation membranes, including alkaline hydrogen separator and proton exchange membranes, still face are hydrogen production efficiency, long-term stability, and cost-effectiveness under working conditions, which exhibited critical issues that need to be addressed as a top priority. This review comprehensively presented research progress on AEMs in recent years, providing a thorough understanding of academic studies and industrial applications. It focused on analyzing the chemical structure of polymers and the performance of AEMs and established the relationship between the structure and efficiency of the membranes. This review aimed to identify approaches for improving AEM ion conductivity and alkaline stability. Additionally, future research directions for the commercialization of anion exchange membranes were discussed based on the analysis and assessment of the current applications of AEMs in patents.

14.
Genet Med ; : 101146, 2024 Apr 24.
Article in English | MEDLINE | ID: mdl-38676451

ABSTRACT

INTRODUCTION: Measuring effects of genomic sequencing (GS) on patients and families is critical for translational research. We aimed to develop and validate an instrument to assess parents' perceived utility of pediatric diagnostic GS. METHODS: Informed by a five-domain conceptual model, the study comprised five steps: (1) item writing, (2) cognitive testing, (3) pilot testing and item reduction, (4) psychometric testing, and (5) evaluation of construct validity. Parents of pediatric patients who had received results of clinically indicated GS participated in structured cognitive interviews and two rounds of surveys. After eliminating items based on theory and quantitative performance, we conducted an exploratory factor analysis and calculated Pearson correlations with related instruments. RESULTS: We derived the 21-item Pediatric Diagnostic version of the GENEtic Utility (GENE-U) scale, which has a two-factor structure that includes an Informational Utility subscale (16 items, α = 0.91) and an Emotional Utility subscale (5 items, α = 0.71). Scores can be summed to calculate a Total scale score (α = 0.87). The Informational Utility subscale was strongly associated with empowerment and personal utility of GS, and the Emotional Utility subscale was moderately associated with psychosocial impact and depression and anxiety. DISCUSSION: The Pediatric Diagnostic GENE-U scale demonstrated good psychometric performance in this initial evaluation and could be a useful tool for translational genomics researchers, warranting additional validation.

15.
Clin Infect Dis ; 78(Supplement_2): S126-S130, 2024 Apr 25.
Article in English | MEDLINE | ID: mdl-38662698

ABSTRACT

BACKGROUND: The 2030 target for schistosomiasis is elimination as a public health problem (EPHP), achieved when the prevalence of heavy-intensity infection among school-aged children (SAC) reduces to <1%. To achieve this, the new World Health Organization guidelines recommend a broader target of population to include pre-SAC and adults. However, the probability of achieving EPHP should be expected to depend on patterns in repeated uptake of mass drug administration by individuals. METHODS: We employed 2 individual-based stochastic models to evaluate the impact of school-based and community-wide treatment and calculated the number of rounds required to achieve EPHP for Schistosoma mansoni by considering various levels of the population never treated (NT). We also considered 2 age-intensity profiles, corresponding to a low and high burden of infection in adults. RESULTS: The number of rounds needed to achieve this target depends on the baseline prevalence and the coverage used. For low- and moderate-transmission areas, EPHP can be achieved within 7 years if NT ≤10% and NT <5%, respectively. In high-transmission areas, community-wide treatment with NT <1% is required to achieve EPHP. CONCLUSIONS: The higher the intensity of transmission, and the lower the treatment coverage, the lower the acceptable value of NT becomes. Using more efficacious treatment regimens would permit NT values to be marginally higher. A balance between target treatment coverage and NT values may be an adequate treatment strategy depending on the epidemiological setting, but striving to increase coverage and/or minimize NT can shorten program duration.


Subject(s)
Disease Eradication , Schistosoma mansoni , Schistosomiasis mansoni , Humans , Schistosomiasis mansoni/epidemiology , Schistosomiasis mansoni/drug therapy , Schistosomiasis mansoni/prevention & control , Child , Animals , Adolescent , Schistosoma mansoni/drug effects , Adult , Prevalence , Mass Drug Administration , Public Health , Young Adult , Child, Preschool , Anthelmintics/therapeutic use , Anthelmintics/administration & dosage , Male , Female , Middle Aged
16.
J Vasc Surg ; 2024 Apr 10.
Article in English | MEDLINE | ID: mdl-38608965

ABSTRACT

OBJECTIVE: Society for Vascular Surgery guidelines recommend revascularization for patients with intermittent claudication (IC) if it can improve patient function and quality of life. However, it is still unclear if patients with IC achieve a significant functional benefit from surgery compared with medical management alone. This study examines the relationship between IC treatment modality (operative vs nonoperative optimal medical management) and patient-reported outcomes for physical function (PROMIS-PF) and satisfaction in social roles and activities (PROMIS-SA). METHODS: We identified patients with IC who presented for index evaluation in a vascular surgery clinic at an academic medical center between 2016 and 2021. Patients were stratified based on whether they underwent a revascularization procedure during follow-up vs continued nonoperative management with medication and recommended exercise therapy. We used linear mixed-effect models to assess the relationship between treatment modality and PROMIS-PF, PROMIS-SA, and ankle-brachial index (ABI) over time, clustering among repeat patient observations. Models were adjusted for age, sex, diabetes, Charlson Comorbidity Index, Clinical Frailty Score, tobacco use, and index ABI. RESULTS: A total of 225 patients with IC were identified, of which 40% (n = 89) underwent revascularization procedures (42% bypass; 58% peripheral vascular intervention) and 60% (n = 136) continued nonoperative management. Patients were followed up to 6.9 years, with an average follow-up of 5.2 ± 1.6 years. Patients who underwent revascularization were more likely to be clinically frail (P = .03), have a lower index ABI (0.55 ± 0.24 vs 0.72 ± 0.28; P < .001), and lower baseline PROMIS-PF score (36.72 ± 8.2 vs 40.40 ± 6.73; P = .01). There were no differences in patient demographics or medications between treatment groups. Examining patient-reported outcome trends over time; there were no significant differences in PROMIS-PF between groups, trends over time, or group differences over time after adjusting for covariates (P = .07, P = .13, and P =.08, respectively). However, all patients with IC significantly increased their PROMIS-SA over time (adjusted P = .019), with patients managed nonoperatively more likely to have an improvement in PROMIS-SA over time than those who underwent revascularization (adjusted P = .045). CONCLUSIONS: Patient-reported outcomes associated with functional status and satisfaction in activities are similar for patients with IC for up to 7 years, irrespective of whether they undergo treatment with revascularization or continue nonoperative management. These findings support conservative long-term management for patients with IC.

18.
Nat Genet ; 56(5): 752-757, 2024 May.
Article in English | MEDLINE | ID: mdl-38684898

ABSTRACT

Health equity is the state in which everyone has fair and just opportunities to attain their highest level of health. The field of human genomics has fallen short in increasing health equity, largely because the diversity of the human population has been inadequately reflected among participants of genomics research. This lack of diversity leads to disparities that can have scientific and clinical consequences. Achieving health equity related to genomics will require greater effort in addressing inequities within the field. As part of the commitment of the National Human Genome Research Institute (NHGRI) to advancing health equity, it convened experts in genomics and health equity research to make recommendations and performed a review of current literature to identify the landscape of gaps and opportunities at the interface between human genomics and health equity research. This Perspective describes these findings and examines health equity within the context of human genomics and genomic medicine.


Subject(s)
Genomics , Health Equity , Humans , Genomics/methods , United States , Genome, Human , National Human Genome Research Institute (U.S.)
19.
Stem Cell Reports ; 19(5): 604-617, 2024 May 14.
Article in English | MEDLINE | ID: mdl-38670111

ABSTRACT

Cell culture technology has evolved, moving from single-cell and monolayer methods to 3D models like reaggregates, spheroids, and organoids, improved with bioengineering like microfabrication and bioprinting. These advancements, termed microphysiological systems (MPSs), closely replicate tissue environments and human physiology, enhancing research and biomedical uses. However, MPS complexity introduces standardization challenges, impacting reproducibility and trust. We offer guidelines for quality management and control criteria specific to MPSs, facilitating reliable outcomes without stifling innovation. Our fit-for-purpose recommendations provide actionable advice for achieving consistent MPS performance.


Subject(s)
Cell Culture Techniques , Humans , Reproducibility of Results , Cell Culture Techniques/methods , Quality Control , Organoids/cytology , Microphysiological Systems
20.
Int J Biol Macromol ; 269(Pt 2): 131852, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38679253

ABSTRACT

Particulates and organic toxins, such as microplastics and dye molecules, are contaminants in industrial wastewater that must be purified due to environmental and sustainability concerns. Carboxylated cellulose acetate (CTA-COOH) nanofibrous membranes were fabricated using electrospinning followed by an innovative one-step surface hydrolysis/oxidation replacing the conventional two-step reactions. This approach offers a new pathway for the modification strategy of cellulose-based membranes. The CTA-COOH membrane was utilized for the removal of particulates and cationic dyes through filtration and adsorption, respectively. The filtration performance of the CTA-COOH nanofibrous membrane was carried out; high separation efficiency and low pressure drop were achieved, in addition to the high filtration selectivity against 0.6-µm and 0.8-µm nanoparticles. A cationic Bismarck Brown Y, was employed to challenge the adsorption capability of the CTA-COOH nanofibrous membrane, where the maximum adsorption capacity of the membrane for BBY was 158.73 mg/g. The self-standing CTA-COOH membrane could be used to conduct adsorption-desorption for 17 cycles with the regeneration rate as high as 97.0 %. The CTA-COOH nanofibrous membrane has excellent mechanical properties and was employed to manufacture a spiral wound adsorption cartridge, which exhibited remarkable separation efficiency in terms of treated water volume, which was 5.96 L, and retention rate, which was 100 %.


Subject(s)
Cellulose , Coloring Agents , Membranes, Artificial , Nanofibers , Water Pollutants, Chemical , Cellulose/chemistry , Cellulose/analogs & derivatives , Nanofibers/chemistry , Coloring Agents/chemistry , Coloring Agents/isolation & purification , Adsorption , Water Pollutants, Chemical/chemistry , Water Pollutants, Chemical/isolation & purification , Water Purification/methods , Particulate Matter/chemistry , Filtration/methods , Wastewater/chemistry
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