Publications by authors named "Michael Young"

642 Publications

Factors influencing job satisfaction among dentists during the new normal of the COVID-19 pandemic in Indonesia: A structural equation modeling approach.

Work 2021 Oct 5. Epub 2021 Oct 5.

Department of Finance and Management, Asian Institute of Management. Paseo de Roxas, Legazpi Village, Makati, Metro Manila, Philippines.

Background: Dentistry is one of the highest risk occupations that face COVID-19, especially in countries that are severely affected by the pandemic, such as Indonesia.

Objective: The purpose of the study was to determine factors influencing job satisfaction among dentists during the new normal of COVID-19 pandemic in Indonesia by utilizing the Structural Equation Modeling (SEM) approach.

Methods: A total of 310 Indonesian dentists voluntary completed an online questionnaire, which contained 58 questions. Several latent variables such as perceived severity of COVID-19, staff cooperation and management commitment, personal protective equipment, job stress, working hours, income, and overall job satisfaction were analyzed simultaneously.

Results: SEM revealed perceived severity of COVID-19 had significant effects on job stress (β:0.394, p = 0.025) and the utilization of personal protective equipment (β:0.757, p = 0.001). Subsequently, job stress (β:-0.286, p = 0.001), working hours (β:0.278, p = 0.018), income (β:0.273, p = 0.003), personal protective equipment (β:0.145, p = 0.038), and staff cooperation & management commitment (β:0.091, p = 0.002) were found to have significant effects on overall job satisfaction. In addition, management & staff cooperation was found to have a significant association with job stress reduction (β:-0.319, p = 0.003) which subsequently led to higher satisfaction.

Conclusions: The current study is one of the first that analyzed job satisfaction among dentists in Indonesia during the global COVID-19 pandemic. The integrated latent variables can be applied and extended to evaluate job satisfaction among dentists during the COVID-19 pandemic in other countries. Finally, this study contributed as a theoretical foundation for policymakers to enhance the job satisfaction of dentists during the COVID-19 pandemic.
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http://dx.doi.org/10.3233/WOR-210479DOI Listing
October 2021

The Evaluation of Preference and Perceived Quality of Health Communication Icons Associated with COVID-19 Prevention Measures.

Healthcare (Basel) 2021 Aug 27;9(9). Epub 2021 Aug 27.

School of Industrial Engineering and Engineering Management, Mapúa University, 658 Muralla St., Intramuros, Manila 1002, Philippines.

Icons have been widely utilized to describe and promote COVID-19 prevention measures. The purpose of this study was to analyze the preference and subjective design features of 133 existing icons associated with COVID-19 prevention measures published by the health and medical organizations of different countries. The 133 icons represent nineteen different function names, such as "Wash Hands" and "Wear Face Mask". A total of 57 participants were recruited to perform two different tests: ranking test and subjective rating test. The ranking test was conducted to elicit the preference ranking of seven icon designs representing each function name. It was followed by a subjective rating test using 13 semantic scales on the two most preferred icons to analyze their perceived quality. Spearmen correlation was applied to derive the possible correlations between users' rankings and the semantic scales, and Friedman's test was also performed to determine the true difference between ranking in terms of each semantic scale to provide a fully meaningful interpretation of the data. Generally, findings from the current study showed that the image presented in the icon is the key point that affects the icons' perceived quality. Interestingly, Spearman's correlation analysis between preference ranking and semantic scales showed that vague-clear, weak-strong, incompatible-compatible, and ineffective-effective were the four strongest semantic scales that highly correlated with the preference ranking. Considering the significant relationships between the semantic distances and the functions, images depicted in an icon should be realistic and as close as possible to its respected function to cater to users' preferences. In addition, the results of Spearman's correlation and Friedman's test also inferred that compatibility and clarity of icon elements are the main factors determining a particular icon's preferability. This study is the first comprehensive study to evaluate the icons associated with the COVID-19 prevention measures. The findings of this study can be utilized as the basis for redesigning icons, particularly for icons related to COVID-19 prevention measures. Furthermore, the approach can also be applied and extended for evaluating other medical icons.
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http://dx.doi.org/10.3390/healthcare9091115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8465661PMC
August 2021

Associations of perinatal exposure to PM with gestational weight gain and offspring birth weight.

Environ Res 2021 Sep 22;204(Pt B):112087. Epub 2021 Sep 22.

Department of Epidemiology, University of Washington, Seattle, WA, 98195, USA.

Background: PM have been associated with weight change in animal models and non-pregnant populations. Evidence of associations between PM and gestational weight gain (GWG), an important determinant of course and outcomes of pregnancy, and subsequent birth outcomes is limited.

Methods: The study was conducted among a subset of participants from the Omega Study, a prospective pregnancy cohort. Exposure to PM (μg/m) was ascertained for participants (N = 855) based on their residential address using a validated national spatiotemporal model. Adjusted multivariable linear regression models were used to estimate associations of trimester-specific and pregnancy-month PM exposures with early (<20 weeks gestation), late (≥20 weeks gestation), and total GWG and infant birth weight. Stratified models and product terms were used to examine whether pre-pregnancy BMI (ppBMI) and infant sex modified the associations.

Results: Average monthly PM exposure during the first, second, and third trimesters were 7.3 μg/m, 7.9 μg/m, and 7.7 μg/m, respectively. Higher third trimester PM exposure was associated with higher late (0.40 kg per 5 μg/m (McDowell et al., 2018); 95%CI: 0.12, 0.67) and total (0.35 kg; 95%CI: 0.01, 0.70) GWG among participants with normal ppBMI. Higher second month PM exposure was associated with lower early (-0.70 kg; 95%CI: 1.22, -0.18), late (-0.84 kg; 95% CI: 1.54, -0.14), and total (-1.70 kg; 95%CI: 2.57, -0.82) GWG among participants with overweight/obese ppBMI. Product terms between PM and ppBMI were significant for second month PM exposure and early (p-value = 0.01) and total GWG (p-value<0.01). Higher third trimester PM exposure was associated with higher birth weight, though higher fourth month PM exposure was associated with lower birth weight, particularly among those with normal ppBMI and male infants.

Conclusions: Associations of PM with GWG vary by exposure window and ppBMI, while associations of PM with birth weight potentially vary by exposure window, ppBMI and infant sex. Further exploration of associations between PM and maternal/child health outcomes are needed.
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http://dx.doi.org/10.1016/j.envres.2021.112087DOI Listing
September 2021

Learning when to wait and when to act.

Learn Behav 2021 Sep 20. Epub 2021 Sep 20.

Kansas State University, Manhattan, KS, USA.

Choosing how long to wait in order to optimize reward is a complex decision. We embedded these decisions within a video-game environment in which the amount of reward smoothly increased the longer one waited. The availability of external cues varied in order to determine how they affected the decision to wait to achieve the goal of maximizing the reward rate. As a group, people were most optimal when they could directly observe the growth in reward, and this information overshadowed a static color cue that did not require extended observation. These results were considered within the context of improving the choice between acting versus waiting in order to maximize reward rates.
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http://dx.doi.org/10.3758/s13420-021-00482-5DOI Listing
September 2021

The societal cost of unintentional childhood injuries in Aotearoa.

N Z Med J 2021 Aug 13;134(1540):25-37. Epub 2021 Aug 13.

Director of Child Health and Paediatric Emergency Specialist, Starship Hospital; Honorary Senior Lecturer, University of Auckland, Auckland.

Aims: To estimate the burden and inequity of unintentional childhood injury for children in Aotearoa.

Methods: We used administrative data from the Accident Compensation Corporation (ACC) and the Ministry of Health to estimate the direct, indirect and intangible costs of unintentional injuries in children aged under 15 and the inequity of the impact of childhood injury on discretionary household income. We used an incidence approach and attributed all costs arising from injuries to the year in which those injuries were sustained.

Results: 257,000 children experienced unintentional injury in 2014, resulting in direct and indirect costs of almost $400 million. The burden of lost health and premature death was the equivalent of almost 200 full lives at perfect health. Pacific children had the highest incidence rates. Māori had the lowest rates of ACC claims but the highest rate of emergency department attendance. Children living with the highest levels of socioeconomic deprivation had the highest rate of hospital admission following injury. The proportional loss in discretionary income arising from an injury was higher for Māori and Pacific compared to non-Māori, non-Pacific households.

Conclusion: The burden of unintentional childhood injury is greater than previously reported and has a substantial and iniquitous societal impact. There should be a focus on addressing inequities in incidence and access to care in order to reduce inequities in health and financial impact.
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August 2021

Palladium-Catalyzed Regioselective Arylation of Unprotected Allylamines.

JACS Au 2021 Jan 9;1(1):13-22. Epub 2020 Dec 9.

Department of Chemistry and Biochemistry, School of Green Chemistry and Engineering, The University of Toledo, Toledo, Ohio 43606, United States.

Palladium-catalyzed organometallic transformations of free amines are often unsuccessful due to side reactions, such as oxidation, that can occur. However, the ability to furnish the free amine products from these reactions is important for improving the utility and sustainability of these processes, especially for accessing their potential as medicinal and agrochemical agents. Notably, the 3,3-diarylallylamine motif is prevalent in a variety of biologically relevant structures, yet there are few catalytic approaches to their synthesis, and none involving the free amine. Herein, we describe a simple protocol for the arylation of cinnamylamines and the diarylation of terminal allylamines to generate a diverse group of 3,3-diarylallylamine products using a Pd precatalyst. Key features of the method are the ability to access relatively mild conditions that facilitate a broad substrate scope as well as direct diarylation of terminal allylamine substrates. In addition, several complex and therapeutically relevant molecules are included to demonstrate the utility of the transformation.
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http://dx.doi.org/10.1021/jacsau.0c00003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8395680PMC
January 2021

A quantitative analysis of accuracy, reliability and bias in judgements of functional analyses.

J Exp Anal Behav 2021 Sep 31;116(2):166-181. Epub 2021 Aug 31.

Endicott College.

Functional analysis can be considered a diagnostic assessment that behavior analysts use to determine behavioral function. Such a diagnosis ultimately requires a yes or no decision (i.e., a variable maintains a behavior, or it does not) that is determined by both subjective (clinical judgement) and objective (data) variables. Accurate and reliable identification of function is essential for successful treatment, yet behavior analysts' interpretation of data relies on their ability to detect visual differences in graphed data. Some research indicates that behavior analysts have questionable reliability in their visual analysis. To further examine the reliability, accuracy, and bias in visual analysis of functional analysis graphs, we simulated functional analysis results and surveyed 121 BCBA-Ds experienced in visual analysis. We then examined reliability of responses and used a signal detection theory approach to analyze accuracy and bias. Findings suggest that reliability and accuracy of judgements are questionable, and exploration of decision aids is warranted.
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http://dx.doi.org/10.1002/jeab.711DOI Listing
September 2021

Exercise hormone irisin is a critical regulator of cognitive function.

Nat Metab 2021 08 20;3(8):1058-1070. Epub 2021 Aug 20.

Cardiovascular Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Identifying secreted mediators that drive the cognitive benefits of exercise holds great promise for the treatment of cognitive decline in ageing or Alzheimer's disease (AD). Here, we show that irisin, the cleaved and circulating form of the exercise-induced membrane protein FNDC5, is sufficient to confer the benefits of exercise on cognitive function. Genetic deletion of Fndc5/irisin (global Fndc5 knock-out (KO) mice; F5KO) impairs cognitive function in exercise, ageing and AD. Diminished pattern separation in F5KO mice can be rescued by delivering irisin directly into the dentate gyrus, suggesting that irisin is the active moiety. In F5KO mice, adult-born neurons in the dentate gyrus are morphologically, transcriptionally and functionally abnormal. Importantly, elevation of circulating irisin levels by peripheral delivery of irisin via adeno-associated viral overexpression in the liver results in enrichment of central irisin and is sufficient to improve both the cognitive deficit and neuropathology in AD mouse models. Irisin is a crucial regulator of the cognitive benefits of exercise and is a potential therapeutic agent for treating cognitive disorders including AD.
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http://dx.doi.org/10.1038/s42255-021-00438-zDOI Listing
August 2021

Chronic social isolation signals starvation and reduces sleep in Drosophila.

Nature 2021 09 18;597(7875):239-244. Epub 2021 Aug 18.

Laboratory of Genetics, The Rockefeller University, New York, NY, USA.

Social isolation and loneliness have potent effects on public health. Research in social psychology suggests that compromised sleep quality is a key factor that links persistent loneliness to adverse health conditions. Although experimental manipulations have been widely applied to studying the control of sleep and wakefulness in animal models, how normal sleep is perturbed by social isolation is unknown. Here we report that chronic, but not acute, social isolation reduces sleep in Drosophila. We use quantitative behavioural analysis and transcriptome profiling to differentiate between brain states associated with acute and chronic social isolation. Although the flies had uninterrupted access to food, chronic social isolation altered the expression of metabolic genes and induced a brain state that signals starvation. Chronically isolated animals exhibit sleep loss accompanied by overconsumption of food, which resonates with anecdotal findings of loneliness-associated hyperphagia in humans. Chronic social isolation reduces sleep and promotes feeding through neural activities in the peptidergic fan-shaped body columnar neurons of the fly. Artificial activation of these neurons causes misperception of acute social isolation as chronic social isolation and thereby results in sleep loss and increased feeding. These results present a mechanistic link between chronic social isolation, metabolism, and sleep, addressing a long-standing call for animal models focused on loneliness.
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http://dx.doi.org/10.1038/s41586-021-03837-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8429171PMC
September 2021

Decade Long Temporal Trends in Revascularization for Patients With Diabetes Mellitus (From the Northern New England Cardiovascular Disease Study Group).

Am J Cardiol 2021 10 13;157:1-7. Epub 2021 Aug 13.

University of Vermont Medical Center, Burlington, Vermont.

The FREEDOM trial demonstrated superiority of coronary artery bypass grafting (CABG) for patients with diabetes mellitus (DM) and multivessel coronary artery disease (MV CAD) as compared to percutaneous coronary intervention (PCI) with drug eluting stent (PCI-DES). We sought to study the impact of the FREEDOM trial on clinical practice. We studied trends in the use of CABG vs. PCI and factors associated with revascularization strategy among 6,985 patients with concomitant CAD and MV CAD at 7 centers pre- and post-trial (2008-2012 vs. 2013-2017) as well as hospital outcomes. Multivariable mixed effects logistic regression was performed to identify risk factors associated with choice of revascularization strategy among the patients with 3-vessel CAD (3V CAD). 41% of patients had 3V CAD and 18% were ≥75 years of age. While PCI-DES was the preferred strategy in 2-vessel CAD (2V CAD), 72% of patients with 3V CAD underwent CABG. For patients with 3V CAD, the ratio of CABG to PCI-DES procedures was 2.47 over the decade and did not differ pre- and post-trial (adjusted odds ratio (OR) for CABG (vs. PCI) 1.01, 95% confidence interval (CI) 0.84-1.20). Independent risk factors of CABG among patients with DM and 3V CAD included peripheral arterial disease and absence of prior myocardial infarction and prior PCI. The risk factors for PCI were female sex (OR 0.60, 95% CI 0.50-0.73, p<0.001) and age ≥75 (OR 0.50, 95% CI 0.35-0.72, p<0.001). Center based variability was observed for CABG vs. PCI (center effect, rho=14%, p<0.001). In conclusion, PCI-DES is the preferred strategy for DM patients with MV CAD. Yet, among those with 3V CAD, CABG was chosen in ¾ of patients with no change in clinical practice related to the publication of the FREEDOM trial.
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http://dx.doi.org/10.1016/j.amjcard.2021.07.017DOI Listing
October 2021

Ruptured Distal Medial Lenticulostriate Artery Aneurysm Treated With Transcortical-Transventricular Approach.

Cureus 2021 Jul 5;13(7):e16186. Epub 2021 Jul 5.

Neurological Surgery, Advocate Christ Medical Center, Oak Lawn, USA.

We report a case of a 48-year-old female who presented with abulia and headaches. Head CT (HCT) demonstrated a left caudate intracerebral hemorrhage (ICH) with extension into the left lateral ventricle. Diagnostic cerebral angiogram showed a left distal medial lenticulostriate artery (MLSA) aneurysm with remote left parietal Spetzler-Martin grade 3 arteriovenous malformation (AVM). The patient underwent an endoscope-assisted transcortical-transventricular approach to the distal MLSA aneurysm with complete excision and evacuation of the intraventricular hemorrhage (IVH) postoperatively; the patient had no further neurologic deficits and recovered well from her initial hemorrhage. Ruptured MLSA aneurysms are a very rare cause of spontaneous ICH. Urgent treatment of these aneurysms is needed to prevent further rebleeding. We present a novel operative technique utilizing an endoscope-assisted transcortical-transventricular approach to a ruptured distal MLSA aneurysm with successful excision of the aneurysm.
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http://dx.doi.org/10.7759/cureus.16186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336517PMC
July 2021

Molecular basis for substrate recruitment to the PRMT5 methylosome.

Mol Cell 2021 09 5;81(17):3481-3495.e7. Epub 2021 Aug 5.

Broad Institute, Cambridge, MA, USA; Medical Oncology, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, USA. Electronic address:

PRMT5 is an essential arginine methyltransferase and a therapeutic target in MTAP-null cancers. PRMT5 uses adaptor proteins for substrate recruitment through a previously undefined mechanism. Here, we identify an evolutionarily conserved peptide sequence shared among the three known substrate adaptors (CLNS1A, RIOK1, and COPR5) and show that it is necessary and sufficient for interaction with PRMT5. We demonstrate that PRMT5 uses modular adaptor proteins containing a common binding motif for substrate recruitment, comparable with other enzyme classes such as kinases and E3 ligases. We structurally resolve the interface with PRMT5 and show via genetic perturbation that it is required for methylation of adaptor-recruited substrates including the spliceosome, histones, and ribosomal complexes. Furthermore, disruption of this site affects Sm spliceosome activity, leading to intron retention. Genetic disruption of the PRMT5-substrate adaptor interface impairs growth of MTAP-null tumor cells and is thus a site for development of therapeutic inhibitors of PRMT5.
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http://dx.doi.org/10.1016/j.molcel.2021.07.019DOI Listing
September 2021

The neuroethics of disorders of consciousness: a brief history of evolving ideas.

Brain 2021 Aug 4. Epub 2021 Aug 4.

Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114,USA.

Neuroethical questions raised by recent advances in the diagnosis and treatment of disorders of consciousness are rapidly expanding, increasingly relevant, and yet underexplored. The aim of this thematic review is to provide a clinically applicable framework for understanding the current taxonomy of disorders of consciousness and to propose an approach to identifying and critically evaluating actionable neuroethical issues that are frequently encountered in research and clinical care for this vulnerable population. Increased awareness of these issues and clarity about opportunities for optimizing ethically-responsible care in this domain are especially timely given recent surges in critically ill patients with unusually prolonged disorders of consciousness associated with coronavirus disease 2019 (COVID-19) around the world. We begin with an overview of the field of neuroethics: what it is, its history and evolution in the context of biomedical ethics at large. We then explore nomenclature used in disorders of consciousness, covering categories proposed by the American Academy of Neurology, the American Congress of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research, including definitions of terms such as coma, the vegetative state, unresponsive wakefulness syndrome, minimally conscious state, covert consciousness, and the confusional state. We discuss why these definitions matter, and why there has been such evolution in this nosology over the years, from Jennett and Plum in 1972 to the Multi-Society Task Force in 1994, the Aspen Working Group in 2002 and up until the 2018 American and 2020 European Disorders of Consciousness guidelines. We then move to a discussion of clinical aspects of disorders of consciousness, the natural history of recovery, and ethical issues that arise within the context of caring for persons with disorders of consciousness. We conclude with a discussion of key challenges associated with assessing residual consciousness in disorders of consciousness, potential solutions and future directions, including integration of crucial disability rights perspectives.
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http://dx.doi.org/10.1093/brain/awab290DOI Listing
August 2021

Association Between COVID-19 Exposure and Self-reported Compliance With Public Health Guidelines Among Essential Employees at an Institution of Higher Education in the US.

JAMA Netw Open 2021 07 1;4(7):e2116543. Epub 2021 Jul 1.

Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins.

Importance: Detailed analysis of infection rates paired with behavioral and employee-reported risk factors is vital to understanding how transmission of SARS-CoV-2 infection may be exacerbated or mitigated in the workplace. Institutions of higher education are heterogeneous work units that supported continued in-person employment during the COVID-19 pandemic, providing a test site for occupational health evaluation.

Objective: To evaluate the association between self-reported protective behaviors and prevalence of SARS-CoV-2 infection among essential in-person employees during the first 6 months of the COVID-19 pandemic in the US.

Design, Setting, And Participants: This cross-sectional study was conducted from July 13 to September 2, 2020, at an institution of higher education in Fort Collins, Colorado. Employees 18 years or older without symptoms of COVID-19 who identified as essential in-person workers during the first 6 months of the pandemic were included. Participants completed a survey, and blood and nasal swab samples were collected to assess active SARS-CoV-2 infection via quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) and past infection by serologic testing.

Exposure: Self-reported practice of protective behaviors against COVID-19 according to public health guidelines provided to employees.

Main Outcomes And Measures: Prevalence of current SARS-CoV-2 infection detected by qRT-PCR or previous SARS-CoV-2 infection detected by an IgG SARS-CoV-2 testing platform. The frequency of protective behavior practices and essential workers' concerns regarding contracting COVID-19 and exposing others were measured based on survey responses.

Results: Among 508 participants (305 [60.0%] women, 451 [88.8%] non-Hispanic White individuals; mean [SD] age, 41.1 [12.5] years), there were no qRT-PCR positive test results, and only 2 participants (0.4%) had seroreactive IgG antibodies. Handwashing and mask wearing were reported frequently both at work (480 [94.7%] and 496 [97.8%] participants, respectively) and outside work (465 [91.5%] and 481 [94.7%] participants, respectively). Social distancing was reported less frequently at work (403 [79.5%]) than outside work (465 [91.5%]) (P < .001). Participants were more highly motivated to avoid exposures because of concern about spreading the infection to others (419 [83.0%]) than for personal protection (319 [63.2%]) (P < .001).

Conclusions And Relevance: In this cross-sectional study of essential workers at an institution of higher education, when employees reported compliance with public health practices both at and outside work, they were able to operate safely in their work environment during the COVID-19 pandemic.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.16543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8295736PMC
July 2021

Durable Antibody Responses in Staff at Two Long-Term Care Facilities, during and Post SARS-CoV-2 Outbreaks.

Microbiol Spectr 2021 09 21;9(1):e0022421. Epub 2021 Jul 21.

Department of Microbiology, Immunology and Pathology, Colorado State Universitygrid.47894.36, Fort Collins, Colorado, USA.

SARS-CoV-2 has had a disproportionate impact on nonhospital health care settings, such as long-term-care facilities (LTCFs). The communal nature of these facilities, paired with the high-risk profile of residents, has resulted in thousands of infections and deaths and a high case fatality rate. To detect presymptomatic infections and identify infected workers, we performed weekly surveillance testing of staff at two LTCFs, which revealed a large outbreak at one of the sites. We collected serum from staff members throughout the study and evaluated it for binding and neutralization to measure seroprevalence, seroconversion, and type and functionality of antibodies. At the site with very few incident infections, we detected that over 40% of the staff had preexisting SARS-CoV-2 neutralizing antibodies, suggesting prior exposure. At the outbreak site, we saw rapid seroconversion following infection. Neutralizing antibody levels were stable for many weeks following infection, suggesting a durable, long-lived response. Receptor-binding domain antibodies and neutralizing antibodies were strongly correlated. The site with high seroprevalence among staff had two unique introductions of SARS-CoV-2 into the facility through seronegative infected staff during the period of study, but these did not result in workplace spread or outbreaks. Together, our results suggest that a high seroprevalence rate among staff can contribute to immunity within a workplace and protect against subsequent infection and spread within a facility. Long-term care facilities (LTCFs) have been disproportionately impacted by COVID-19 due to their communal nature and high-risk profile of residents. LTCF staff have the ability to introduce SARS-CoV-2 into the facility, where it can spread, causing outbreaks. We tested staff weekly at two LTCFs and collected blood throughout the study to measure SARS-CoV-2 antibodies. One site had a large outbreak and infected individuals rapidly generated antibodies after infection. At the other site, almost half the staff already had antibodies, suggesting prior infection. The majority of these antibodies bind to the receptor-binding domain of the SARS-CoV-2 spike protein and are potently neutralizing and stable for many months. The non-outbreak site had two unique introductions of SARS-CoV-2 into the facility, but these did not result in workplace spread or outbreaks. Our results reveal that high seroprevalence among staff can contribute to immunity and protect against subsequent infection and spread within a facility.
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http://dx.doi.org/10.1128/Spectrum.00224-21DOI Listing
September 2021

Costs associated with transradial access and same-day discharge after percutaneous coronary intervention: a systematic review and meta-analysis.

Rev Cardiovasc Med 2021 Jun;22(2):429-438

Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756, USA.

Transradial access for PCI (TRI) along with same day discharge (SDD) is associated with varying estimates of cost savings depending on the population studied, the clinical scenario and application to low-risk vs high-risk patients. A summary estimate of the true cost savings of TRI and SDD are unknown. We searched the PubMed, EMBASE®, CINAHL® and Google Scholar® databases for published studies on hospitalization costs of TRI and SDD. Primary outcome of interest in all included studies was the cost saving with TRI (or SDD), inflation-corrected US$ 2018 values using the medical consumer price index. For meta-analytic synthesis, we used Hedges' summary estimate (g) in a random-effects framework of the DerSimonian and Laird model, with inverse variance weights. Heterogeneity was quantified using the I statistic. The cost savings of TRI from four US studies of 349,757 patients reported a consistent and significant cost saving associated with TRI after accounting for currency inflation, of US$ 992 (95% CI US$ 850-1,134). The cost savings of SDD from six US studies of 1,281,228 patients, after inflation-correcting to the year 2018, were US$ 3,567.58 (95% CI US$ 2,303-4,832). In conclusion, this meta-analysis demonstrates that TRI and SDD are associated with mean cost reductions of by approximately US$ 1,000/patient and US$ 3,600/patient, respectively, albeit with wide heterogeneity in the cost estimates. When combined with the safety of TRI and SDD, this meta-analysis underscores the value of combining TRI and SDD pathways and calls for a wide-ranging practice change in the direction of TRI and SDD.
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http://dx.doi.org/10.31083/j.rcm2202048DOI Listing
June 2021

Determining Factors Affecting the Acceptance of Medical Education eLearning Platforms during the COVID-19 Pandemic in the Philippines: UTAUT2 Approach.

Healthcare (Basel) 2021 Jun 22;9(7). Epub 2021 Jun 22.

Industrial Engineering Department, BINUS Graduate Program-Master of Industrial Engineering, Bina Nusantara University, Jakarta 11480, Indonesia.

eLearning has been the medium of delivery of medical educational institutions to address the scarcity of medical professionals during the COVID-19 pandemic. In this study, the Unified Theory of Acceptance and Use of Technology (UTAUT2) was extended to determine the factors affecting the acceptance of eLearning platforms to medical education in the Philippines during the COVID-19 pandemic. A total of 360 medical students voluntary participated and answered an online questionnaire that consisted of 40 questions. Structural Equation Modeling (SEM) indicated that performance expectancy was found to have the highest effect on behavioral intention, which was followed by learning value and instructor characteristics. A high behavioral intention was found to affect the actual use of eLearning platforms. Interestingly, social influence and habit were found not to be significant to behavioral intentions. This study is the first study that has explored the acceptance of eLearning platforms among medical students in the Philippines during the COVID-19 pandemic. The findings can be a theoretical guideline of the Commission on Higher Education of the Philippines for eLearning platforms. Finally, the framework would be very valuable for enhancing the open innovation in eLearning platforms in medical fields worldwide.
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http://dx.doi.org/10.3390/healthcare9070780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305344PMC
June 2021

Consumer Preference Analysis on Attributes of Milk Tea: A Conjoint Analysis Approach.

Foods 2021 Jun 15;10(6). Epub 2021 Jun 15.

Industrial Engineering Department, BINUS Graduate Program-Master of Industrial Engineering, Bina Nusantara University, Jakarta 11480, Indonesia.

Milk tea is a famous drink that has been heavily consumed since 2011. This study aimed to determine the combination of milk tea attributes that were most preferred using a Conjoint Analysis Approach. Specifically, this study utilized different attributes such as the size of tapioca pearls, sugar level, price range, brands, type of milk tea, cream cheese inclusion, and the amount of ice. Conjoint analysis with the orthogonal design was utilized to evaluate the preference of milk tea among consumers. The results showed that pearl size was the attribute most considered by consumers (29.137%), followed by sugar level (17.373%), the amount of ice (17.190%), the type of drink (13.421%), price (11.207%), and the least considered were cream cheese inclusion (9.525%) and the brands (2.147%). The findings of this study will be beneficial to milk tea firms about consumer preferences regarding the various attributes of milk tea. Finally, the result of this study could be applicable to different beverage-focused studies worldwide.
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http://dx.doi.org/10.3390/foods10061382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232735PMC
June 2021

Palladium-Catalyzed γ,γ'-Diarylation of Free Alkenyl Amines.

J Am Chem Soc 2021 Jul 23;143(27):10352-10360. Epub 2021 Jun 23.

Department of Chemistry & Biochemistry, School of Green Chemistry & Engineering, The University of Toledo, 2801 W. Bancroft St., Mailstop 602, Toledo, Ohio 43606, United States of America.

The direct difunctionalization of alkenes is an effective way to construct multiple C-C bonds in one-pot using a single functional group. The regioselective dicarbofunctionalization of alkenes is therefore an important area of research to rapidly obtain complex organic molecules. Herein, we report a palladium-catalyzed γ,γ'-diarylation of free alkenyl amines through interrupted chain walking for the synthesis of -selective alkenyl amines. Notably, while 1,3-dicarbofunctionalization of allyl groups is well precedented, the present disclosure allows 1,3-dicarbofunctionalization of highly substituted allylamines to give highly -selective trisubsubstituted olefin products. This cascade reaction operates via an unprotected amine-directed Mizoroki-Heck (MH) pathway featuring a β-hydride elimination to selectively chain walk to furnish a new terminal olefin which then generates the -selective alkenyl amines around the sterically crowded allyl moiety. This operationally simple protocol is applicable to a variety of cyclic, branched, and linear secondary and tertiary alkenylamines, and has a broad substrate scope with regard to the arene coupling partner as well. Mechanistic studies have been performed to help elucidate the mechanism, including the presence of a likely unproductive side C-H activation pathway.
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http://dx.doi.org/10.1021/jacs.1c04261DOI Listing
July 2021

Proximal basilar artery hemorrhage after submaximal angioplasty for intracranial atherosclerotic disease presenting as a large vessel occlusion treated with pipeline embolization device.

J Cerebrovasc Endovasc Neurosurg 2021 Jun 17;23(2):145-151. Epub 2021 Jun 17.

Department of Neurosurgery, Advocate Christ Medical Center, Oak Lawn, IL, USA.

Iatrogenic vessel perforation from endovascular intervention is a devastating complication that commonly is treated with vessel sacrifice. We present a unique case of an iatrogenic proximal basilar artery perforation after submaximal angioplasty in a 67-year-old male presenting with an acute basilar artery occlusion with underlying intracranial atherosclerotic disease. Telescoping flow-diverting stents were then deployed to reconstruct the vessel wall with resulting active hemorrhage resolution. Our case documents a successful deployment of flow-diverting stents with resolution of active hemorrhage after an iatrogenic basilar artery perforation.
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http://dx.doi.org/10.7461/jcen.2021.E2020.11.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8256018PMC
June 2021

Percutaneous management strategies for STEMI with coexisting aneurysmal coronary- to-pulmonary artery fistula: a case report.

Eur Heart J Case Rep 2021 May 16;5(5):ytab157. Epub 2021 May 16.

Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03766, USA.

Background: Coexistence of coronary artery fistulas and atherosclerotic coronary artery disease (CAD) is rare.

Case Summary: We present a unique case of a patient initially presenting with an anterior ST-elevation myocardial infarction, subsequently found to have two-vessel CAD and an aneurysmal left coronary-to-right pulmonary artery fistula.

Discussion: After discussion with the patient and a multidisciplinary discussion with the heart team, consisting of cardiovascular surgery, interventional cardiology, and vascular surgery, a percutaneous approach was chosen. He underwent successful multivessel percutaneous coronary intervention followed by fistula embolization.
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http://dx.doi.org/10.1093/ehjcr/ytab157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189310PMC
May 2021

Fine-Scale Air Pollution Models for Epidemiologic Research: Insights From Approaches Developed in the Multi-ethnic Study of Atherosclerosis and Air Pollution (MESA Air).

Curr Environ Health Rep 2021 06;8(2):113-126

Departments of Environmental and Occupational Health Sciences, Epidemiology, and Medicine, University of Washington, Seattle, WA, USA.

Purpose Of Review: Epidemiological studies of short- and long-term health impacts of ambient air pollutants require accurate exposure estimates. We describe the evolution in exposure assessment and assignment in air pollution epidemiology, with a focus on spatiotemporal techniques first developed to meet the needs of the Multi-ethnic Study of Atherosclerosis and Air Pollution (MESA Air). Initially designed to capture the substantial variation in pollutant levels and potential health impacts that can occur over small spatial and temporal scales in metropolitan areas, these methods have now matured to permit fine-scale exposure characterization across the contiguous USA and can be used for understanding long- and short-term health effects of exposure across the lifespan. For context, we highlight how the MESA Air models compare to other available exposure models.

Recent Findings: Newer model-based exposure assessment techniques provide predictions of pollutant concentrations with fine spatial and temporal resolution. These validated models can predict concentrations of several pollutants, including particulate matter less than 2.5 μm in diameter (PM), oxides of nitrogen, and ozone, at specific locations (such as at residential addresses) over short time intervals (such as 2 weeks) across the contiguous USA between 1980 and the present. Advances in statistical methods, incorporation of supplemental pollutant monitoring campaigns, improved geographic information systems, and integration of more complete satellite and chemical transport model outputs have contributed to the increasing validity and refined spatiotemporal spans of available models. Modern models for predicting levels of outdoor concentrations of air pollutants can explain a substantial amount of the spatiotemporal variation in observations and are being used to provide critical insights into effects of air pollutants on the prevalence, incidence, progression, and prognosis of diseases across the lifespan. Additional enhancements in model inputs and model design, such as incorporation of better traffic data, novel monitoring platforms, and deployment of machine learning techniques, will allow even further improvements in the performance of pollutant prediction models.
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http://dx.doi.org/10.1007/s40572-021-00310-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278964PMC
June 2021

Unrecognized perforation into the anterior interventricular vein complicating PCI for anterior STEMI: An unexpected detour.

Clin Case Rep 2021 May 5;9(5):e04055. Epub 2021 May 5.

Dartmouth-Hitchcock Medical Center Heart and Vascular Center Geisel School of Medicine Lebanon NH USA.

Large iatrogenic coronary artery perforations require rapid management; however, operators must be able to recognize guidewire perforation into cardiac veins in order to avoid causing further complications with standard salvage strategies.
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http://dx.doi.org/10.1002/ccr3.4055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142412PMC
May 2021

Factors Influencing Repurchase Intention in Drive-Through Fast Food: A Structural Equation Modeling Approach.

Foods 2021 May 27;10(6). Epub 2021 May 27.

BINUS Graduate Program-Master of Industrial Engineering, Industrial Engineering Department, Bina Nusantara University, Jakarta 11480, Indonesia.

The drive-through fast-food industry has been one of the fastest businesses growing over the past decades in developing countries, including the Philippines. The purpose of this study was to evaluate factors influencing costumers' repurchase intention in a drive-through fast food in the Philippines by utilizing the structural equation modeling (SEM) approach. A total of 305 Filipinos answered the online questionnaire, which contained 38 questions. The results of SEM indicated that subjective appetite (SA) was found to have a significant direct effect on menu options (MO). Consequently, MO was found to have significant direct effects on imagery elaboration (IE), vividness (VV), and convenience (CO), and an indirect effect on order accuracy (OA). Finally, SA, MO, IE, VV, OA, and CO were found to have significant effects on satisfaction (S), which subsequently led to loyalty (L) and repurchase intention (RI). Interestingly, MO was found to have the highest indirect effect on RI, indicating that MO is an important consideration for RI. This is the first comprehensive study evaluating drive-through fast food in the Philippines. The causal relationships of the present study can be applied and extended to evaluate the repurchase intention of drive-through fast food in other countries.
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http://dx.doi.org/10.3390/foods10061205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8227228PMC
May 2021

Geographic and Demographic Variability in Transcatheter Aortic Valve Replacement Dispersion in the United States.

J Am Heart Assoc 2021 06 31;10(12):e019588. Epub 2021 May 31.

The Dartmouth Institute of Health Policy and Clinical PracticeDartmouth College Lebanon NH.

Background Transcatheter aortic valve replacement (TAVR) has transformed the management of aortic valve stenosis. However, little national data are available characterizing the geographic and demographic dispersion of this disruptive technology relative to surgical aortic valve replacement (SAVR). Methods and Results In this US claims-based study, we analyzed a 100% sample of fee-for-service Medicare beneficiaries from 2012 to 2017 and examined national rates of TAVR versus SAVR. Procedure rates were compared across years as a function of age, sex, race, and geography for TAVR and SAVR beneficiaries. There was significant growth in TAVR from 15.4 beneficiaries/100 000 enrollees in 2012 to 90.6 in 2017 (<0.001). SAVR rates declined from 92.8 beneficiaries/100 000 enrollees in 2012 to 63.5 in 2017 (<0.001). The growth of TAVR varied as a function of age (<0.0001). While TAVR was the dominant strategy among beneficiaries ≥85 and 75 to 84 years old, SAVR was more common among beneficiaries 65 to 74 years old. TAVR was also used more frequently than SAVR among women (<0.001). While TAVR increased among all races, it was less commonly used among non-White beneficiaries (<0.001). Contemporary use of TAVR relative to SAVR varied significantly by geographic location, with a TAVR:SAVR ratio in 2017 of 1.24 in the Midwest and 1.68 in the Northeast (<0.001). Conclusions In 2017, the number of Medicare beneficiaries receiving TAVR exceeded SAVR for the first time in the United States. There is significant variation, however, in the geographic expansion of TAVR and in patient demographics relative to SAVR.
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http://dx.doi.org/10.1161/JAHA.120.019588DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8477877PMC
June 2021

Sex-specific differences in presentations and determinants of outcomes after endovascular thrombectomy for large vessel occlusion stroke.

J Neurol 2021 May 29. Epub 2021 May 29.

Neurology, Massachusetts General Hospital, 55 Fruit St, WAC-7-721, Boston, MA, USA.

Introduction: Sex-specific differences in ischemic stroke outcomes are prevalent. We sought to investigate sex differences in the determinants of reperfusion and functional outcomes after endovascular thrombectomy (EVT) for emergent large vessel occlusion ischemic stroke (ELVO).

Methods: Patients presenting to a single referral center with an anterior circulation ELVO that underwent EVT from 2011 to 2019 were included in this retrospective analysis. Sex differences in history, presentation, adequate reperfusion (TICI 2b-3), and 90-day good outcome [delta modified Rankin Scale (mRS) ≤ 2 from pre-stroke] were examined. Multivariable logistic regression analyses were performed to assess sex-specific associations with outcomes.

Results: Three hundred and eighty-one consecutive ELVO patients were identified. Women (N = 193) were older (75 vs 64 years, p < 0.0001), had more pre-stroke disability (17% vs 9%, p = 0.032), more atrial fibrillation (41% vs 30%, p = 0.033), but less carotid atherosclerosis (8% vs 16%, p = 0.027). Rates of TICI 2b-3 and good outcome were similar between sexes. Carotid atherosclerosis (OR 0.315, 95% CI 0.130, 0.762) and dissection (OR 0.124, 95% CI 0.027, 0.569) independently decreased the odds of TICI 2b-3 among men but not women. Older age, more severe stroke, and not achieving TICI 2b-3 independently decreased the odds of good outcome among both sexes, while prior stroke (OR 0.258, 95% CI 0.083, 0.797) and hemorrhagic transformation (OR 0.111, 0.021, 0.592) were determinants exclusive to men.

Conclusion: In a real-world analysis of ELVO stroke patients treated with EVT, we found that despite advanced age and more pre-stroke disability, women have comparable reperfusion rates and functional outcomes compared to men. Sex-specific determinants of reperfusion and functional outcome were identified that require further study.
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http://dx.doi.org/10.1007/s00415-021-10628-0DOI Listing
May 2021

Enhanced migration of engrafted retinal progenitor cells into the host retina via disruption of glial barriers.

Mol Vis 2021 10;27:300-308. Epub 2021 May 10.

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.

Purpose: Migration and integration remain critical challenges for stem cell replacement therapy. Glial barriers play an important role in preventing cell migration and integration. The purpose of this study was to investigate the effect and mechanisms of chondroitinase ABC on the migration of murine retinal progenitor cells (mRPCs) transplanted into the subretinal space of B6 mice.

Methods: mRPCs were harvested from the neural retinas of P1 enhanced green fluorescent protein (GFP) B6 mice. Two μl containing 2 × 10 expanded RPCs alone or combined with chondroitinase ABC in suspension were injected into the subretinal space of the recipient B6 mice. Immunohistochemistry was performed on the recipient B6 retinas to evaluate the glial barrier formation and migration of the mRPCs. Western blotting was also used to check the expression of the glial barriers.

Results: Glial fibrillary acidic protein (GFAP) and vimentin could be seen around the transplanted mRPCs in the B6 mice. Formation of glial barriers prevented the migration of donor cells into the retinal layers. Chondroitinase ABC promoted the migration and survival rates of the engrafted retinal progenitor cells in the retinal layers of recipient B6 mice. Injection induced upregulation of GFAP, chondroitin, and CD44 expression. Chondroitinase ABC disrupted the glial barriers. The CD44 around the mRPCs was much lower in the chondroitinase group. However, the CD44 in the retinal layers was considerably higher in the chondroitinase group. With the employment of chondroitinase ABC, more cells migrated into the outer nuclear layer or inner nuclear layer. The chondroitin and CD44 expression decreased 3 weeks after transplantation in the chondroitinase ABC group.

Conclusions: Chondroitinase ABC degraded glial barriers and enhanced the migration of transplanted mouse retinal progenitor cells. Chondroitinase ABC may also have induced activation of the CD44 signaling pathway to exert the effect.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8131176PMC
May 2021

Emerging Consciousness at a Clinical Crossroads.

AJOB Neurosci 2021 Apr-Sep;12(2-3):148-150

Massachusetts General Hospital.

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http://dx.doi.org/10.1080/21507740.2021.1904032DOI Listing
May 2021
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