Objective: The purpose of this study was to identify barriers and design interventions to promote adherence to 2017 Guideline for Syncope Evaluation and Management. Methods: Focus groups and interviews were conducted to understand preferences, needs and barriers from patients and providers. Educational materials for patients were developed following a co-design, iterative process with patients, providers and hospital staff. The academic medical center's (AMC) Patient Education Department and Patient & Family Advisory Council reviewed materials to ensure health literacy. We piloted usability and feasibility of delivering the materials to a small cohort of patients. Results: From Feb to March 2020, 24 patients were asked to watch the video. Twenty-two watched the intake video; of those 8 watched the discharge video. 95% of participants found the intake video informational and 86% would recommend it to others; 100% found the discharge video informational and would recommend it to others. Patients who watched both videos reported the videos improved their overall stay. Conclusion: Our study described a patient-clinician-researcher codesign process and demonstrated feasibility of tools developed to communicate risk and uncertainty with patients and facilitate shared decision making in syncope evaluation. Innovation: Engaging end users in developing interventions is critical for sustained practice change.
The heteropatriarchal ideology undergirding sport has been recognized as a root cause of gender biases across multiple domains. Gender bias persists, although there is a growing number of female sport psychology practitioners entering the field. As such, continued exploration of the impact gender biases and stereotypes has on women’s career experiences remains necessary. Utilizing a feminist standpoint framework, the purpose of this research was to explore the career experiences of female sport psychology practitioners, centering the role of sexism. Seventeen cisgender female sport psychology practitioners participated in semistructured interviews from May 2021 to July 2021. Participants’ ages ranged from 24 to 46 years, with a mean age of 33.2 years, and years of applied experience ranged from 2 to 21 years, with a mean of 7.4 years. Reflective thematic analysis revealed five themes: (a) perceived lack of credibility, (b) compensation disparities, (c) sexist attitudes, (d) pregnancy and parenthood, and (e) advocating for self and others. Participants’ experiences suggest female sport psychology practitioners are confronted with blatant sexism in the workplace that poses professional challenges and career obstacles they have resiliently navigated. This study contributes to the growing body of literature pertaining to women in sport by purposefully exploring the juncture of gender with other identity factors (e.g., age, sexual orientation, and credibility).
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver and represents a significant global health burden. Management of HCC can be challenging due to multiple factors, including variable expectations for treatment outcomes. Several treatment options are available, each with specific eligibility and ineligibility criteria, and are provided by a multidisciplinary team of specialists. Radiologists should be aware of the types of treatment options available, as well as the criteria guiding the development of individualized treatment plans. This awareness enables radiologists to contribute effectively to patient-centered multidisciplinary tumor boards for HCC and play a central role in reassessing care plans when the treatment response is deemed inadequate. This comprehensive review aims to equip radiologists with an overview of HCC staging systems, treatment options, and eligibility criteria. The review also discusses the significance of imaging in HCC diagnosis, treatment planning, and monitoring treatment response. Furthermore, we highlight the crucial branch points in the treatment decision-making process that depend on radiological interpretation. Graphical abstract
Sensing technology has long been an integral part of modern developments that have brought several benefits to various domains ranging from civil and military to commercial and healthcare applications. However, the sensor’s inadequate energy is the primary concern that affects their long-term sustainable operations and remote location deployment. Therefore, self-powered sensors with the ability to scavenge energy from the environment to self-drive the sensor’s operation have received significant attention in recent years. Self-powered sensors with energy harvesting technology can convert the ambient energy available in the environment, such as mechanical, thermal, wave, and solar energy, into electric energy to self-power the sensors for long-term sustainable operations. Self-powered sensors have been a vital part of technological advances since the 21st century and the existing literature has thoroughly studied the fabrication material of self-powered sensors and their energy harvestingmechanisms. However, the current literature lacks a comprehensive review on state-of-the-art design solutions for self-powered sensors and their implementation challenges. To address the limitations of past and current reviews, we have reviewed state-of-the-art architectures of self-powered sensors and their applications in various domains (such as civil, automotive systems, environmental, robotic, human-machine interactions, healthcare and fitness applications). Moreover, following the study of existing designs of self-powered sensors, we provide a general architecture for a self-powered sensor design, and we discuss the implementation challenges of self-powered sensors that affect their long-term operations. These challenges include energy, size, cost, robustness, stability, and Artificial Intelligence (AI). We also discuss possible solutions to address the implementation challenges we have identified to enable the design of cost-effective self-powered sensor-based monitoring systems for diverse applications.
Purpose Few studies have examined the risk factors for postoperative healthcare resource utilization (HRU) among minimally invasive partial nephrectomy (MIPN), minimally invasive prostatectomy (MIP), and cystectomy (Cx). The aim of this study is to assess if operative duration (OD) is a predictor of HRU in this population. Methods The ACS-NSQIP database was filtered for MIPN, MIP, and Cx. Patient characteristics and intraoperative variables were examined. HRU was defined as prolonged length of stay (LOS), unplanned readmission within 30 days, and discharge to continued care facility. Multivariate regression analysis was used to identify independent predictors of HRU. Results 18,904 MIPN, 50,807 MIP, and 12,451 Cx were included. For MIPN, HRU was seen in 13.9% of cases < 1.75 h, increasing to 36.2% in OD > 4.5 h (p < 0.001). For MIP, HRU was seen in 10.6% of OD < 2 h, increasing to 32.2% for OD > 4.9 h (p < 0.001). For Cx, 57% of those with OD > 8.5 h required HRU compared to 42.1% for OD < 3.3 h (p < 0.001). On multivariate analyses, OD was an independent predictor for increased HRU for all procedures regardless of patient characteristics or comorbidities. For MIPN, OD > 4.5 h had 3.5-fold increased use of HRU (p < 0.001). For MIP, OD > 5 h had 3.7-fold increased use of HRU (p < 0.001). For Cx, OD > 8.5 h demonstrated a twofold increased use of HRU (p < 0.001). Conclusions OD during MIPN, MIP, and Cx is an independent predictor of increased HRU irrespective of patient comorbidities. Patients with OD > 4.5 h for MIPN, > 5 h for MIP, and > 8.5 h for Cx have 3.5-fold, 3.7-fold, and twofold increased risk of HRU, respectively.
The blood–brain barrier (BBB) undergoes functional changes with aging which may contribute to cognitive decline. A novel, diffusion prepared arterial spin labeling-based MRI technique can measure the rate of water exchange across the BBB ( k w ) and may thus be sensitive to age-related alterations in water exchange at the BBB. However, studies investigating relationships between k w and cognition have reported different directions of association. Here, we begin to investigate the direction of associations between k w and cognition in different brain regions, and their possible underpinnings, by evaluating links between k w , cognitive performance, and MRI markers of cerebrovascular dysfunction and/or damage. Forty-seven healthy older adults (age range 61–84) underwent neuroimaging to obtain whole-brain measures of k w , cerebrovascular reactivity (CVR), and white matter hyperintensity (WMH) volumes. Additionally, participants completed uniform data set (Version 3) neuropsychological tests of executive function (EF) and episodic memory (MEM). Voxel-wise linear regressions were conducted to test associations between k w and cognitive performance, CVR, and WMH volumes. We found that k w in the frontoparietal brain regions was positively associated with cognitive performance but not with CVR or WMH volumes. Conversely, k w in the basal ganglia was negatively associated with cognitive performance and CVR and positively associated with regional, periventricular WMH volume. These regionally dependent associations may relate to different physiological underpinnings in the relationships between k w and cognition in neocortical versus subcortical brain regions in older adults.
BACKGROUND Increasing evidence suggests that enlarged perivascular spaces (ePVS) are associated with cognitive dysfunction in aging. However, the pathogenesis of ePVS remains unknown. Here, we tested the possibility that baseline cerebrovascular dysfunction, as measured by a magnetic resonance imaging measure of cerebrovascular reactivity, contributes to the later development of ePVS. METHODS Fifty cognitively unimpaired, older adults (31 women; age range, 60–84 years) underwent magnetic resonance imaging scanning at baseline and follow-up separated by ≈2.5 years. ePVS were counted in the basal ganglia, centrum semiovale, midbrain, and hippocampus. Cerebrovascular reactivity, an index of the vasodilatory capacity of cerebral small vessels, was assessed using carbon dioxide inhalation while acquiring blood oxygen level-dependent magnetic resonance images. RESULTS Low baseline cerebrovascular reactivity values in the basal ganglia were associated with increased follow-up ePVS counts in the basal ganglia after controlling for age, sex, and baseline ePVS values (estimate [SE]=−3.18 [0.96]; P =0.002; [95% CI, −5.11 to −1.24]). This effect remained significant after accounting for self-reported risk factors of cerebral small vessel disease (estimate [SE]=−3.10 [1.00]; P =0.003; [CI, −5.11 to −1.09]) and neuroimaging markers of cerebral small vessel disease (estimate [SE]=−2.72 [0.99]; P =0.009; [CI, −4.71 to −0.73]). CONCLUSIONS Our results demonstrate that low baseline cerebrovascular reactivity is a risk factor for later development of ePVS.
Changes in skeletal muscle are an important aspect of overall health. The collection of human muscle to study cellular and molecular processes for research requires a needle biopsy procedure which in itself can induce changes in the tissue. To investigate the effect of repeat tissue sampling, we collected skeletal muscle biopsy samples from vastus lateralis separated by 7 days. Cellular infiltrate, central nucleation, enlarged extracellular matrix and rounding of muscle fibers were used as indices to define muscle damage, and we found that 16/26 samples (61.5%) revealed at least 2 of these symptoms in the secondary biopsy. The presence of damage influenced outcome measures usually obtained in human biopsies. Damaged muscle showed an increase in the number of small fibers even though average fiber and fiber type specific cross-sectional area (CSA) were not different. This included higher numbers of embryonic myosin heavy chain positive fibers (p=0.001) as well as elevated satellite cell number (p=0.02) in the damaged areas and higher variability in satellite cell count in the total area (p=0.04). Collagen content was higher in damaged (p=0.0003) as well as non-damaged areas (p=0.05) of the muscle sections of the damaged compared to the non-damaged group. Myofibrillar protein and RNA fractional synthesis rates were not significantly different between the damaged compared to the non-damaged group. Results indicate that common outcomes as well as outcome variability in human muscle tissue are affected by previous biopsies. Therefore, the extent of potential damage should be assessed when performing repeated biopsies.
Paul Robeson's global memorialization poorly represents the extent to which the famous African American activist, actor, athlete, singer, and scholar impacted international culture and politics. Robeson's memorials, while few and far between, particularly in the United States, reside primarily within college campuses and theatrical and musical productions, alongside a few more traditional plaques, works of public art, and his own work. While there has been some interest in these various memorials, commemorations, and works of Robeson, no one has yet explored one of the most widespread and historically loaded aspects of his commemoration: the Paul Robeson Tomato. This heirloom tomato, developed in the Soviet Union, has, as one seed website states, "a cult following." Reading through various gardening and seed websites, we find that the tomato has a special place among heirlooms. At the same time, the digital and print networks conveying information about the tomato and Paul Robeson silence and twist Robeson's memorialization given political, cultural, and ecological contexts. This leads us to ask a number of questions, particularly how we might understand this tomato within the broader memory and memorialization of Paul Robeson? How does this human-environment interaction of more-than-human memory impact Robeson's legacy? And how can we further think of living memory beyond human experience to the remainder of the natural landscape around us and the power it has? This project explores these notions of living memory, more-than-human, and memorialization in the context of the histories which envelop Paul Robeson and the tomato.
The vertebrate brain emerged more than ~500 million years ago in common evolutionary ancestors. To systematically trace its cellular and molecular origins, we established a spatially resolved cell type atlas of the entire brain of the sea lamprey—a jawless species whose phylogenetic position affords the reconstruction of ancestral vertebrate traits—based on extensive single-cell RNA-seq and in situ sequencing data. Comparisons of this atlas to neural data from the mouse and other jawed vertebrates unveiled various shared features that enabled the reconstruction of cell types, tissue structures and gene expression programs of the ancestral vertebrate brain. However, our analyses also revealed key tissues and cell types that arose later in evolution. For example, the ancestral brain was probably devoid of cerebellar cell types and oligodendrocytes (myelinating cells); our data suggest that the latter emerged from astrocyte-like evolutionary precursors in the jawed vertebrate lineage. Altogether, our work illuminates the cellular and molecular architecture of the ancestral vertebrate brain and provides a foundation for exploring its diversification during evolution.
Due to the vulnerability of neonatal ungulates, selection of a birth site can have important implications for offspring survival and thus fitness of the mother. We studied parturition site selection in cow Elk in southeastern Kentucky, United States, using a use–availability framework to evaluate the effects of landscape variables sampled at multiple spatial grains on the relative probability of use of parturition sites. We identified 81 Elk parturition sites during May–Aug 2020–2022 and fit several candidate resource selection function models using a sample of 24,314 random locations to characterize habitat availability. Using an information-theoretic approach to rank candidate models, we identified two top-performing models (cumulative ωi = 0.97), which indicated that at fine spatial grains (~10- and 30-m pixels) parturient cow Elk selected for intermediate canopy cover and lower terrain ruggedness compared to available locations. At coarse grains (250–1,000-m buffers/neighborhoods), Elk selected against vegetation greenness/biomass, for higher topographic positions, for closer proximity to major roads, and with higher solar radiation potential. We also found evidence that Elk responded positively to forest/open edge densities at coarse grains, demonstrating that calving habitat throughout the Kentucky Elk Restoration Zone is associated with heterogeneous landscapes resulting from surface mine reclamation. As a result, habitat management actions should aim to increase patchy, early successional shrub cover on gentle topography.
RATIONALE Controversies and practice variations exist related to the pharmacologic and nonpharmacologic management of the airway during rapid sequence intubation (RSI). OBJECTIVES To develop evidence-based recommendations on pharmacologic and nonpharmacologic topics related to RSI. DESIGN A guideline panel of 20 Society of Critical Care Medicine members with experience with RSI and emergency airway management met virtually at least monthly from the panel’s inception in 2018 through 2020 and face-to-face at the 2020 Critical Care Congress. The guideline panel included pharmacists, physicians, a nurse practitioner, and a respiratory therapist with experience in emergency medicine, critical care medicine, anesthesiology, and prehospital medicine; consultation with a methodologist and librarian was available. A formal conflict of interest policy was followed and enforced throughout the guidelines-development process. METHODS Panelists created Population, Intervention, Comparison, and Outcome (PICO) questions and voted to select the most clinically relevant questions for inclusion in the guideline. Each question was assigned to a pair of panelists, who refined the PICO wording and reviewed the best available evidence using predetermined search terms. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework was used throughout and recommendations of “strong” or “conditional” were made for each PICO question based on quality of evidence and panel consensus. Recommendations were provided when evidence was actionable; suggestions, when evidence was equivocal; and best practice statements, when the benefits of the intervention outweighed the risks, but direct evidence to support the intervention did not exist. RESULTS From the original 35 proposed PICO questions, 10 were selected. The RSI guideline panel issued one recommendation (strong, low-quality evidence), seven suggestions (all conditional recommendations with moderate-, low-, or very low-quality evidence), and two best practice statements. The panel made two suggestions for a single PICO question and did not make any suggestions for one PICO question due to lack of evidence. CONCLUSIONS Using GRADE principles, the interdisciplinary panel found substantial agreement with respect to the evidence supporting recommendations for RSI. The panel also identified literature gaps that might be addressed by future research.
This study aimed to identify social capital's role in shaping an individual's behavior to share information on social media. The study also investigated the mediation role of information sharing intention (ISI) between the relationship of social capital and information sharing behavior (ISB). Based on the social capital theory (SCT), and theory of planned behavior (TPB), a comprehensive research model was created, and corresponding hypotheses were developed. The study population included all Pakistani Facebook (FB) users, who actively use Facebook for various reasons. Structural equation modelling (SEM) with Smart PLS was used to analyze the data, test hypotheses, and research model. The findings showed that both bonding social capital (BOS) and bridging social capital (BRS) increased the amount of information shared on social media. It is established that BOS supports weakly tied people to strengthen their relationships on social media. The study also reveals that social capital (BOS and BRS) has a direct and positive effect on information-sharing behavior. The results of the indirect effects indicate that ISI is the significant mediator in the relationship between social capital and ISB. The study's findings are helpful for a wide variety of Facebook users for the purposeful and result-oriented information sharing on SNSs. The study also provided a deeper understating of the social capital features, sharing intention, and how these together exert a more significant impact on information sharing behavior on social media. Additionally, the findings will also facilitate SNS developers in improving SNS services while keeping in view the unique features of social capital.
Precision medicine has revolutionized clinical care for patients with cancer through the development of targeted therapy, identification of inherited cancer predisposition syndromes and the use of pharmacogenetics to optimize pharmacotherapy for anticancer drugs and supportive care medications. While germline (patient) and somatic (tumor) genomic testing have evolved separately, recent interest in paired germline/somatic testing has led to an increase in integrated genomic testing workflows. However, paired germline/somatic testing has generally lacked the incorporation of germline pharmacogenomics. Integrating pharmacogenomics into paired germline/somatic genomic testing would be an efficient method for increasing access to pharmacogenomic testing. In this perspective, the authors argue for the benefits of implementing a comprehensive approach integrating somatic and germline testing that is inclusive of pharmacogenomics in clinical practice.
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