Quinnipiac University

The purpose of the present study is to determine if the Protection of Lawful Commerce in Arms Act (PLCAA) of 2005 had a statistically significant effect on gun sales. Using a two-way fixed effects model with state-level annual data for the period 1999-2016, results of the present study suggest that the PLCAA had a significant and positive impact on overall gun sales as measured by background checks. However, this act had no statistically significant effects on long gun (rifle and shotgun) sales. These results suggest that this federal law limiting gun manufacturers’ liability greatly increased handgun sales but had minimal effects on long gun sales. This result suggests that the PLCAA contributed to an increase in the supply of handguns. Since the majority of firearm homicides and suicides are committed using handguns, it is reasonable to assume that this increase in handguns may have resulted in an increase in firearm homicides and suicides.

Introduction The use of electrical neuromodulation has often been limited to those with previous back surgery, peripheral neuropathy, and complex regional pain syndrome. Many patients with severe intractable low back pain were thought to be candidates for spinal cord stimulation (SCS), dorsal root ganglion stimulation, or peripheral nerve stimulation but did not meet the criteria. Recently, additional high-level data has supported the use of SCS in non-surgical low back pain (NSLBP), and United States Food and Drug Administration approval has been granted. The American Society of Pain and Neuroscience (ASPN) executive committee realized an unmet need to develop criteria for patient selection for this specific patient population. This is a NEURON project (neuroscience, education, utilization, risk mitigation, optimal outcomes, and neuromodulation), a living guideline for evolving therapies and indications, and is focused on the use of neuraxial stimulation for the treatment of refractory pain. Methods After board approval, the society accepted nominees for the project, with an emphasis on experience, publication, research, and diversity. The team created an outline for discussion, chose a grading system based on published guidelines, and created consensus points. Results The evidence led to several consensus points to best guide patient selection based on the level of evidence and expert opinion. The results will lead to improved safety and efficacy in implanted patients, and to a new standard for best practices. Conclusion The selection of patients for implantation in those who have NSLBP should be based on published literature, best practice, and expert opinion. This NEURON project will allow for regular updates to create a living guideline that will allow for better assimilation of information to improve safety and efficacy going forward.

Purpose To evaluate the current level of evidence for the use of psychedelics for the management of cancer pain and associated psychological distress. Content Pain is a common symptom of cancer and treatment. However, there are high rates of undertreatment of cancer pain due to the complex underlying biology of the condition, and potentially due to a decrease in opioid prescribing in response to the opioid epidemic. A diagnosis of cancer and cancer‐related pain can trigger high levels of psychological distress throughout cancer treatment. Cancer pain can also be exacerbated by anxiety, depression, quality of life challenges, and fear of death and dying, as well as by fear of recurrence or progression. Several pharmacologic and non‐pharmacologic approaches have been utilized to mitigate pain and symptom burden with some success. However, there remains an unmet need for better management of cancer pain and associated symptoms. Psychedelics, such as lysergic acid diethylamide (LSD), psilocybin, mescaline, and N,N‐dimethyltryptamine (DMT), are under consideration as new pharmacologic strategies for mitigating pain and the distress associated with cancer pain and associated symptom burden. Although published studies are limited, regulatory hurdles have decreased. Many clinical trials are underway to assess further the use of psychedelics and behavioral counseling for patients with cancer and comorbidities such as anxiety or depression. These studies examine both the feasibility and efficacy of psychedelics for pain and psychological distress. Early results are promising, and additional research is needed to understand efficacy and tolerability in broader cancer populations. Implications There is an unmet need to improve pain management in patients with cancer and to mitigate psychological distress. Further research is required to understand the efficacy of psychedelics for the treatment of cancer pain and distress. Recent regulatory changes have paved the way for increased research on the clinical efficacy of psychedelics in cancer.

Introduction Knee osteoarthritis and hip osteoarthritis (OA) are orthopaedic conditions for which total joint arthroplasty (TJA) is the definitive treatment. The correlation of social determinants of health (SDOH) disparities with access to specialized health care such as TJA is of increasing interest. At our institution, SDOH screening was implemented in 2020. The purpose of this study was to identify whether patients with OA who screened positive for SDOH hardship (SDOH positive) were less likely to receive a subsequent TJA. Methods Patients with diagnosis of knee or hip OA who underwent SDOH screening from 2020 to 2023 were identified from our institutional record. The correlation of SDOH-positive screening relative to not screening positive (SDOH negative) with the likelihood of receiving TJA was assessed. The incidence of TJA in these two cohorts was evaluated using multivariable logistic regression controlling for age, sex, race, and ethnicity. Results A total of 2,981 patients were identified fitting the study criteria. The number of SDOH-positive patients was 1,122 (37.6%), and the number of SDOH-negative patients was 1,859 (62.4%). The SDOH-positive group had a significantly lower rate of TJA (9.9% vs. 14.8%, P < 0.0001). When individual SDOH were assessed, transportation insecurity, financial strain, and food insecurity were associated with decreased TJA incidence, with increasing financial strain corresponding to additional decreases in TJA incidence. On multivariable analysis, SDOH-positive status was identified as an independent negative predictor of TJA. Discussion Patients with knee or hip OA screening positive for SDOH disparities had decreased odds of receiving a subsequent TJA. As screening becomes increasingly more common, these findings illustrate how SDOH disparities correlate with access to orthopaedic care and demonstrate the need for intervention after screening, especially in SDOH categories where organizations can provide resources and support, such as access to transportation and food.

Background While the role of chronic preoperative steroid use in orthopedic outcomes has been studied, particularly in hip, knee, and lumbar surgeries, its impact on total shoulder arthroplasty (TSA) outcomes is not well understood. This study aimed to evaluate the impact of chronic preoperative steroid use on early-onset postoperative infectious outcomes and readmission within 30 days following TSA compared to patients without chronic steroid use. Methods A retrospective analysis was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) spanning from 2010–2018. Clinical data including preoperative demographics, operative variables, and 30-day post-TSA outcomes were collected. Groups were balanced using propensity score matching based on gender, age, race, ethnicity, BMI, functional status, ASA, smoking status, alcohol use, year of operation, and comorbidities. A conditional logistic regression model was used to calculate odds ratios for each outcome measure. Results A total of 3,445 identified cases were included in this analysis after propensity score matching, with 1,157 exhibiting chronic steroid use. The steroid group demonstrated significantly greater rates of readmission (OR: 1.86; 95% CI: 1.22–2.81; P = 0.004). No significant differences were observed between groups in all other adverse outcomes, including reoperation, specific infectious outcomes, and combined infectious outcomes. Conclusions Preoperative chronic steroid use is an independent predictor of readmission but not infection following TSA. While the surgeon should be aware of the increased risk of readmission associated with chronic steroid use, the role of steroid use as a risk factor for postoperative infections following TSA may be less pronounced, particularly compared to surgeries of other joints. Further investigation of infectious outcomes and readmissions with longer follow-up is needed to clarify the specific role of chronic preoperative steroid use in adverse outcomes following TSA.

Objectives Breast cancer is an intricate and varied disease exhibiting a range of molecular subgroups and clinical consequences. Epigenetic alterations have become essential players in the pathophysiology of breast cancer because they control gene expression without changing the DNA sequence. This review provides a comprehensive overview of epigenetics' diagnostic, prognostic, and therapeutic implications in breast cancer. This review aims to present a comprehensive study of the function of epigenetics in breast cancer, emphasizing current developments and potential avenues for future research. Methods A narrative review methodology involved an extensive literature search and selection to gather relevant studies and trial data. PubMed, Embase, and Web of Science databases were searched using relevant keywords such as “epigenetics,” “breast cancer,” “DNA methylation,” “histone modification,” “noncoding RNA,” and “linical trials.” Relevant studies and clinical trial data were selected and synthesized to summarize the topic comprehensively. Results The review synthesizes critical findings from current research, underscoring the pivotal role of epigenetic mechanisms in breast cancer initiation, progression, and therapeutic response. It highlights the potential of epigenetic biomarkers for diagnosis and prognosis and the promise of epigenetic-targeted therapies in breast cancer management. Furthermore, the review outlines future directions for research, emphasizing the importance of elucidating the dynamic interplay between epigenetic alterations and tumor microenvironments in shaping breast cancer phenotypes. Conclusions Epigenetic modifications influence breast cancer progression, diagnosis, and therapy. Emerging biomarkers and targeted treatments hold promise, but further research is essential to refine their clinical application and improve personalized cancer management strategies.

Introduction Early life soil-transmitted helminth (STH) infection and diarrhoea are associated with growth faltering, anaemia, impaired child development and mortality. Exposure to faecally contaminated soil inside the home may be a key contributor to enteric infections, and a large fraction of rural homes in low-income countries have soil floors. The objective of this study is to measure the effect of installing concrete floors in homes with soil floors on child STH infection and other maternal and child health outcomes in rural Bangladesh. Methods and analysis The Cement-based flooRs AnD chiLd hEalth trial is an individually randomised trial in Sirajganj and Tangail districts, Bangladesh. Households with a pregnant woman, a soil floor, walls that are not made of mud and no plan to relocate for 3 years will be eligible. We will randomise 800 households to intervention or control (1:1) within geographical blocks of 10 households to account for strong geographical clustering of enteric infection. Laboratory staff and data analysts will be blinded; participants will be unblinded. We will instal concrete floors when the birth cohort is in utero and measure outcomes at child ages 3, 6, 12, 18 and 24 months. The primary outcome is prevalence of any STH infection ( Ascaris lumbricoides , Necator americanus or Trichuris trichiura ) detected by quantitative PCR at 6, 12, 18 or 24 months follow-up in the birth cohort. Secondary outcomes include household floor and child hand contamination with Escherichia coli , extended-spectrum beta-lactamase producing E. coli and STH DNA; child diarrhoea, growth and cognitive development; and maternal stress and depression. Ethics and dissemination Study protocols have been approved by institutional review boards at Stanford University and the International Centre for Diarrheal Disease Research, Bangladesh. We will report findings on ClinicalTrials.gov, in peer-reviewed publications and in stakeholder workshops in Bangladesh. Trial registration number NCT05372068 .

Introduction Preliminary clinical studies have demonstrated that clonidine is an effective adjuvant to spinal anesthesia in neonates and infants. However, the studies conducted previously have had a limited cohort size of 80–100, potentially limiting an accurate measure of its safety. Methods The current study retrospectively examines our 5–6‐year experience with clonidine as an adjuvant to spinal anesthesia in a large cohort of neonates and infants. Results The study cohort included 1420 patients ranging in age from newborn to 36 months (median age 7 months). Ninety‐five percent of the patients tolerated spinal anesthesia without requiring conversion to general anesthesia, and over 73% of the patients did not require any additional intraoperative sedation. Hypotension (sBP ≤ 60 mmHg) was the most common intraoperative event (17%) with one patient requiring the administration of an anticholinergic agent for bradycardia. No serious intraoperative adverse events were noted. Post Anesthesia Care Unit (PACU) Phase I was bypassed in 75% of cases, and the postoperative admission rate was 7%, with the majority (85%) being planned admissions. Fifty‐six patients (4%) returned to the hospital during the first seven postoperative days, primarily for surgical concerns. Conclusions Based on this retrospective, observational study, clonidine appears to be a safe adjuvant to spinal anesthesia for ambulatory surgical procedures in infants and children. We observed a low incidence of intraoperative and postoperative complications.

Objectives Immune checkpoint inhibitors (ICI) upregulate host antitumor immunity, proving efficacy across diverse tumor types. Currently approved ICI treatment primarily targets the programmed cell death receptor 1 (PD-1) and its ligand PD-L1, and cytotoxic T lymphocyte-antigen 4 (CTLA-4). Nivolumab is a monoclonal antibody that targets the human PD-1 receptor and is an entirely human immunoglobulin G4 (IgG4), approved by the FDA for various cancers like advanced melanoma, metastatic renal cell carcinoma, Hodgkin lymphoma, and advanced lung carcinoma. This review will summarise and discuss the recent literature on cardiotoxicity associated with nivolumab therapy. Methods We searched online databases like PubMed, Scopus, Google Scholar, and Embase for articles related to Nivolumab. Results Cardiotoxicity with ICI use is most commonly represented as myocarditis. Patients present with complaints of shortness of breath, palpitations, edema, and fatigue. Takotsubo cardiomyopathy, or broken heart syndrome, is characterized by systolic dysfunction of the left ventricle, mimicking a myocardial infarction but without associated coronary ischemia and with minimal elevation of cardiac enzymes. In the CHECKMATE-037 trial, ventricular arrhythmias occurred in <10% of those who received nivolumab. In a retrospective analysis of patients treated with ICI (predominantly nivolumab monotherapy) for lung cancer, 11% of the patients developed major adverse cardiac events, including myocarditis, non-ST-segment elevated myocardial infarction, supraventricular tachycardia, and pericardial disorders. Conclusion Close collaboration between cardiology and oncology specialists is crucial for early detection and effective management of cardiac complications, enhancing the safety of nivolumab anticancer therapy.

Objectives Acute lymphoblastic leukemia (ALL) is a common hematological malignancy that occurs due to blockage of B-lymphocyte maturation at an early stage of development and differentiation. The Food and Drug Administration approved blinotumomab to manage relapsed/refractory ALL (R/R ALL). This review aimed to determine the comparative efficacy of blinatumomab in treating R/R ALL. Methods Two reviewers searched 3 electronic databases, PubMed, ScienceDirect, and CENTRAL, for all relevant articles published until July 2024. All the articles that met the inclusion criteria were included in the review. Results Four hundred thirty-seven articles were found from the electronic search; however, only 21 articles met the inclusion criteria. A pooled analysis of the outcomes found that blinatumomab resulted in an improvement in both the OS (HR: 0.65; 95% CI: 0.51, 0.82; P =0.0003) and the DFS (HR: 0.57; 95% CI: 0.41, 0.80; P =0.001). Further analysis showed that the CR rate and MRD response of ALL patients to blinatumomab was 51.6% (95% CI: 48.5%, 54.6%; P =0.319) and 64.6% (95% CI: 53.4%, 74.3%; P =0.011), respectively. The safety analysis indicated that the incidence of serious AEs was comparable in patients receiving blinotumomab and those receiving standard chemotherapy (OR: 1.34; 95% CI; 0.91, 1.97; P =0.14). Conclusions The findings show that blinatumomab is superior to standard chemotherapy in improving the OS and DFS of patients with R/R ALL. Furthermore, it has a more favorable safety profile, making it an effective alternative to conventional chemotherapy for managing R/R ALL.

Disaster Medicine is a critical and often neglected component of health care. The World Association for Disaster and Emergency Medicine (WADEM) Board of Directors, as well as the WADEM Student and Young Professional Special Interest Group, recognize the importance of introducing Disaster Medicine concepts early in health care education and have put forth a position statement emphasizing this importance. As leaders in Disaster Medicine, we aim to highlight the need for the integration of Disaster Medicine education into health care profession training. By acknowledging this educational need and by providing recommendations to appropriate stakeholders, we anticipate that this investment in Disaster Medicine education will assist in developing well-prepared health care professionals who will improve prehospital and emergency medicine, public health, and day-to-day health care throughout local and global communities.

INTRODUCTION Differences in adaptive strategies used by individuals and families living with dementia have the potential to impact day‐to‐day well‐being. The Living Well Inventory for Dementia (LWI‐D) is a new measure to capture these strategies and to illuminate new options to support families living with dementia. The Quality of Day Scale (QODS) is a new measure to capture global well‐being in persons based on a shorter temporal frame than traditional quality of life measures. This article summarizes the initial evaluation of the LWI‐D and the QODS for face validity, content validity, and user acceptability. METHODS Initial acceptability and feasibility testing were conducted with a sample of 17 community‐dwelling individuals with early‐stage dementia (Montreal Cognitive Assessment [MoCA] scores of 12–30). After revision and optimization of the two measures, a second pilot test was conducted with a sample of 30 dyads (persons living with dementia and family caregivers) in nursing home, assisted living, and community settings. RESULTS Data from both pilot studies are reported including item analysis and quantitative and qualitative results. Outcomes related to convergent validity between the LWI‐D and the QODS with measures of positive affect‐balance, quality of life, and well‐being are presented. Within‐dyad differences in ratings on both measures are discussed. DISCUSSION The LWI‐D and the QODS are developing measures that warrant further testing and may enhance the ability to (1) identify strengths in living well with dementia, and (2) identify and test new interventions to bolster care and support. Highlights This article describes the process used to develop and test two new measures for research and clinical practice related to positive psychosocial approaches to dementia. The measures were developed with a team that included persons living with Alzheimer's disease as co‐researchers in the process. A novel method of human‐centered design was used to cultivate deep empathy, generate options, and conduct small, iterative tests of prototype measures.

Objectives This review evaluates the long-term outcomes and adverse events associated with chimeric antigen receptor (CAR) T-cell therapy in patients with relapsed/refractory B-cell acute lymphoblastic leukemia (r/r B-ALL). Methods We conducted the search in relevant databases up to June 2024. We included clinical trials on CAR T-cell therapy for patients with r/r B-ALL. Meta-analyses were conducted using Comprehensive Meta-Analysis V3 and Review Manager 5.4. Results Out of 2659 identified studies, 10 were included in this review. The pooled analysis demonstrated a high minimal residual disease-negative complete remission, with an overall event rate (ER) of 70% (95% CI: 61%-78%, I ² =8 8.35%). Anti-CD19 CAR T-cell therapy showed the highest efficacy with an ER of 74.75% (95% CI: 61%-80%, I ² = 89.84%). Combination therapies targeting CD19 and CD22 had an ER of 69% (95% CI: 53%-83%, I ² = 82.56%). Significant adverse effects included cytokine release syndrome with a mean incidence of 81.8% (95% CI: 76.7%-86.9%), neurotoxicity at 33.2% (95% CI: 28.1%-38.3%), and hematologic toxicities at 71.9% (95% CI: 66.4%-77.4%). Conclusions CAR T-cell therapy is a groundbreaking advancement in treating r/r B-ALL, offering high rates of durable remissions.

Species of Placobdella have been the frequent subject of revisionary and alpha-taxonomy in the past 2 decades. Recent molecular analyses introduced uncertainty about the taxonomic status of several broadly distributed and morphologically variable Placobdella species, including Placobdella picta (Verrill 1872), compounded by incomplete original descriptions reliant upon characters that are no longer unique in comparison to modern congeners. We assessed specimens of P. picta to identify any distinct phylogenetic entities that align with our morphological observations of the type series and novel topotype specimens. Using mitochondrial COI and ND1 and nuclear 18S rDNA with Maximum Likelihood and Bayesian Inference, we evaluated species boundaries using species delimitation analyses (ABGD, mPTP, bPTP, and GMYC) and molecular phylogenetics. Our analyses revealed 2 species entities equivalent to 2 non-reciprocal monophyletic clades. Morphological examinations revealed the lectotype was determined to be Placobdella ornata (Verrill 1872), and paralectotypes are other leech species or were poorly preserved and unidentifiable. Due to the problems with the type series, P. picta is now considered a junior synonym of P. ornata. Based on our results, we describe 2 new species: Placobdella unimaculata n. sp. from Connecticut and Placobdella desseri n. sp. from Algonquin Provincial Park, Ontario, Canada.

Objectives Non-Hodgkin lymphomas (NHL) are a diverse group of lymphoproliferative malignancies, often more unpredictable than Hodgkin lymphomas, with a higher likelihood of extranodal spread. NHL’s resistance to standard chemotherapy has increased, leading to a growing interest in personalized treatments like chimeric antigen receptor T-cell therapies (CAR-TCT). Methodology A literature search was conducted across PubMed, ScienceDirect, Google Scholar, and the Cochrane Library for studies on CAR-TCT in NHL treatment published until July 2024. The outcomes assessed included overall survival (OS), event-free survival (EFS), progression-free survival (PFS), objective response rate (ORR), and adverse events (AEs). Data were pooled using RevMan 5.41 and Comprehensive Meta-analysis 3. Results Out of 532 articles, 8 met the inclusion criteria. CAR-TCT significantly improved OS (HR: 0.79; 95% CI: 0.63-1.00; P =0.05) and PFS (HR: 0.46; 95% CI: 0.36-0.58; P <0.00001) compared with standard chemotherapy. However, EFS was not significantly different (HR: 0.54; 95% CI: 0.26-1.09; P =0.09). About 76.6% of NHL patients responded to CAR-TCT, but the ORR was similar between CAR-TCT and standard therapy (MD: 19.23%; 95% CI: −11.34% to 49.80%; P =0.22). Safety analysis found a grade ≥3 AEs incidence comparable to CAR-TCT and standard care. However, CAR-TCT was associated with higher neutropenia risk but lower thrombocytopenia, anemia, and nausea risks. Conclusion CAR-TCT significantly improves OS and PFS in refractory NHL but does not notably impact EFS. While its ORR is comparable to standard chemotherapy, CAR-TCT has a better safety profile, making it a promising treatment option.