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Facilitators and barriers to post-overdose service delivery in Rhode Island emergency departments: A qualitative evaluation.

J Subst Abuse Treat 2021 Apr 14;130:108411. Epub 2021 Apr 14.

Department of Health Services, Policy, and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, United States.

Background: Emergency departments (EDs) in the US have increasingly incorporated interventions that seek to reduce opioid-related morbidity and mortality. However, many of these interventions are underutilized. This study examined ED provider-identified barriers and facilitators to policy-prescribed service provision for patients treated for an opioid overdose in Rhode Island EDs, and opportunities to improve care delivery. Read More

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Understanding young adults' reasons for seeking 'clinically unnecessary' urgent and emergency care: A qualitative interview study.

Health Expect 2021 Jun 12. Epub 2021 Jun 12.

School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.

Background: Studies have identified young adults as more likely to use emergency departments for 'clinically unnecessary' problems, with limited similar evidence for emergency ambulance use. Media portrayals depict young adults as motivated by 'convenience', but little research has explored the reasons for their help-seeking behaviour.

Methods: Qualitative interviews with 16 young adults (18-30) considered by clinicians to have made unnecessary use of emergency ambulance, emergency department or an urgent GP appointment. Read More

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Immune correlates of therapy outcomes in women with cervical cancer treated with chemoradiotherapy: A systematic review.

Cancer Med 2021 Jun 12. Epub 2021 Jun 12.

Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Background: Immune markers have been correlated with prognosis in a variety of solid tumors, including cervical cancer.

Objective: To review the literature on hematologic and immune markers and their association with recurrence and survival among patients with cervical cancer treated with chemoradiation.

Evidence Review: This systematic review was conducted in accordance with PRISMA guidelines via searches of Ovid MEDLINE, Ovid Embase, and the Cochrane Library using keywords regarding cervical cancer, immune markers, and HIV. Read More

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The immune landscape of common CNS malignancies: implications for immunotherapy.

Nat Rev Clin Oncol 2021 Jun 11. Epub 2021 Jun 11.

Department of Neurosurgery, Northwestern University, Chicago, IL, USA.

Immunotherapy has enabled remarkable therapeutic responses across cancers of various lineages, albeit with some notable exceptions such as glioblastoma. Several previous misconceptions, which have impaired progress in the past, including the presence and role of the blood-brain barrier and a lack of lymphatic drainage, have been refuted. Nonetheless, a subset of patients with brain metastases but, paradoxically, not the vast majority of those with gliomas are able to respond to immune-checkpoint inhibitors. Read More

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Exercise attenuates low back pain and alters epigenetic regulation in intervertebral discs in a mouse model.

Spine J 2021 Jun 8. Epub 2021 Jun 8.

Faculty of Dentistry, McGill University, Montreal, Quebec, H3A 0G1, Canada; Alan Edwards Centre for Research on Pain, McGill University, Montreal, Quebec, H3A 0G1, Canada; Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, Japan, 260-8677; Faculty of Medicine, Departments of Pharmacology and Toxicology, Anesthesiology and Neurology and Neurosurgery, McGill University, Montreal, Quebec, H3A 0G1, Canada; Faculty of Medicine, Department of Anesthesiology, University of Minnesota, Minneapolis, MN, 55455, USA. Electronic address:

Background Context: Chronic low back pain (LBP) is a multifactorial disorder with complex underlying mechanisms, including associations with intervertebral disc (IVD) degeneration in some individuals. It has been demonstrated that epigenetic processes are involved in the pathology of IVD degeneration. Epigenetics refers to several mechanisms, including DNA methylation, that have the ability to change gene expression without inducing any change in the underlying DNA sequence. Read More

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Primary OA early joint degeneration induced by ER-stress is mitigated by resveratrol.

Am J Pathol 2021 Jun 8. Epub 2021 Jun 8.

Department of Pediatrics(,) The University of Texas Health Science Center at Houston (UTHealth), TX. Electronic address:

Given the increasing number of people living with OA, due to population aging and rising rates of obesity, there is an urgent need to identify effective treatment and preventions. Two top risk factors for OA, age and obesity, are associated with ER stress. The I-ERS mouse, an ER stress driven model of primary OA, was developed to study the role of ER stress in primary OA susceptibility. Read More

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Prognostic significance of inflammatory response markers for locally advanced squamous cell carcinoma of the external auditory canal and middle ear.

J Radiat Res 2021 Jun 12. Epub 2021 Jun 12.

Department of Radiology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan.

We investigated the prognostic significance and treatment outcomes of pretreatment inflammatory response markers for locally advanced squamous cell carcinoma (SCC) of the external auditory canal (EAC) and middle ear (ME). Between July 2003 and July 2019, 21 patients with SCC of the EAC (n = 18) or ME (n = 3) who received radiotherapy with or without surgery or systemic therapy (radiotherapy alone [n = 2], radiotherapy + systemic therapy [n = 6], radiotherapy + surgery [n = 7], radiotherapy + surgery + systemic therapy [n = 6]) were retrospectively examined. The median radiation dose was 66. Read More

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Transthoracic Echocardiography: Beginner's Guide with Emphasis on Blind Spots as Identified with CT and MRI.

Radiographics 2021 Jun 11:200142. Epub 2021 Jun 11.

From the Departments of Radiology (M.D.G., R.D.M., S.D.K., R.M.B., J.D.M., D.W.G., E.A.R.) and Cardiology (J.M.R.), Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431; and the Uniformed Services University of the Health Sciences, Bethesda, Md (M.D.G., J.M.R., D.W.G., E.A.R.).

Transthoracic echocardiography (TTE) is the primary initial imaging modality in cardiac imaging. Advantages include portability, safety, availability, and ability to assess the morphology and physiology of the heart in a noninvasive manner. Because of this, many patients who undergo advanced imaging with CT or MRI will have undergone prior TTE, particularly when cardiac CT angiography or cardiac MRI is performed. Read More

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Essential Package of Palliative Care for Women With Cervical Cancer: Responding to the Suffering of a Highly Vulnerable Population.

JCO Glob Oncol 2021 Jun;7:873-885

Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland.

Women with cervical cancer, especially those with advanced disease, appear to experience suffering that is more prevalent, complex, and severe than that caused by other cancers and serious illnesses, and approximately 85% live in low- and middle-income countries where palliative care is rarely accessible. To respond to the highly prevalent and extreme suffering in this vulnerable population, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an essential package of palliative care for cervical cancer (EPPCCC). The EPPCCC consists of a set of interventions, medicines, simple equipment, social supports, and human resources, and is designed to be safe and effective for preventing and relieving all types of suffering associated with cervical cancer. Read More

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Substratum stiffness tunes membrane voltage in mammary epithelial cells.

J Cell Sci 2021 Jun 11. Epub 2021 Jun 11.

Departments of Molecular Biology Princeton University, Princeton, NJ 08544, USA.

Membrane voltage (Vm) plays a critical role in the regulation of several cellular behaviors, including proliferation, apoptosis, and phenotypic plasticity. Many of these same behaviors are affected by the stiffness of the underlying extracellular matrix, but the connections between Vm and the mechanical properties of the microenvironment are unclear. Here, we investigated the relationship between matrix stiffness and Vm by culturing mammary epithelial cells on synthetic substrata, the stiffnesses of which mimicked those of the normal mammary gland and breast tumors. Read More

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KCNT1-related epilepsies and epileptic encephalopathies: phenotypic and mutational spectrum.

Brain 2021 Jun 11. Epub 2021 Jun 11.

Pediatric Neurology Department, Lyon University Hospital, 69500 Bron, France.

Variants in KCNT1, encoding a sodium-gated potassium channel (subfamily T member 1), have been associated with a spectrum of epilepsies and neurodevelopmental disorders. These range from familial autosomal dominant or sporadic sleep-related hypermotor epilepsy ((AD)SHE) to epilepsy of infancy with migrating focal seizures (EIMFS) and include developmental and epileptic encephalopathies (DEE). This study aims to provide a comprehensive overview of the phenotypic and genotypic spectrum of KCNT1 mutation-related epileptic disorders in 248 individuals, including 66 unpreviously published and 182 published cases, the largest cohort reported so far. Read More

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Difficult Dialogues: Negotiating Faculty Responses to a Gender Bias Literacy Training Program.

Qual Rep 2016 Jul 11;21(7):1243-1265. Epub 2016 Jul 11.

University of Wisconsin-Madison, USA.

Diversity training is challenging and can evoke strong emotional responses from participants including resistance, shame, confusion, powerlessness, defensiveness, and anger. These responses create complex situations for both presenters and other learners. We observed 3 experienced presenters as they implemented 41 gender bias literacy workshops for 376 faculty from 42 STEMM (science, technology, engineering, mathematics, medicine) departments at one Midwestern university. Read More

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Perception Toward Exposure Risk of COVID-19 Among Health Workers in Vietnam: Status and Correlated Factors.

Front Public Health 2021 25;9:589317. Epub 2021 May 25.

Department of Psychological Medicine, National University Health System, Singapore, Singapore.

Hospital staff are at the frontline for the prevention and control of COVID-19. Understanding their perception of exposure risk is, therefore, important during the early phase of this pandemic. In this study, we evaluated the perception regarding risk of exposure to COVID-19 among Vietnamese hospital staff in Vietnam. Read More

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Insulin Resistance and Blood-Brain Barrier Dysfunction Underlie Neuroprogression in Bipolar Disorder.

Front Psychiatry 2021 25;12:636174. Epub 2021 May 25.

Department of Medical Neuroscience, Dalhousie University, Halifax, NS, Canada.

Bipolar disorder (BD) often progresses to a more chronic and treatment resistant (neuroprogressive) course. Identifying which patients are at risk could allow for early intervention and prevention. Bipolar disorder is highly comorbid with metabolic disorders including type II diabetes mellitus (T2DM), hypertension, obesity, and dyslipidemia. Read More

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Feelings and Emotions of Nurses Related to Dying and Death of Patients - A Pilot Study.

Psychol Res Behav Manag 2021 4;14:705-717. Epub 2021 Jun 4.

Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland.

Introduction: The aim of the study, conducted in selected inpatient units, was to evaluate and analyse the feelings and emotions which accompany nurses during their work when they face the death of patients.

Material And Methods: A total of 160 nurses were invited to participate in the study. The study group consisted of 40 nurses from each of the four departments of a municipal hospital: a surgery unit, an internal medicine unit, a hospital emergency department (ER) and an intensive care unit (ICU). Read More

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Clinical Analysis and Management of Long-Stay Patients.

Authors:
Chienhsiu Huang

Int J Gen Med 2021 4;14:2351-2357. Epub 2021 Jun 4.

Department of Internal Medicine, Division of Chest Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.

Background: Worldwide, a certain proportion of patients stay for long periods. Reduction of length of stay is a critical intervention to optimize in-hospital resource utilization. Length of stay itself is a reliable quality index for healthcare systems. Read More

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A framework for automated gene selection in genomic applications.

Genet Med 2021 Jun 10. Epub 2021 Jun 10.

Laboratory for Molecular Medicine, Mass General Brigham Personalized Medicine, Cambridge, MA, USA.

Purpose: An efficient framework to identify disease-associated genes is needed to evaluate genomic data for both individuals with an unknown disease etiology and those undergoing genomic screening. Here, we propose a framework for gene selection used in genomic analyses, including applications limited to genes with strong or established evidence levels and applications including genes with less or emerging evidence of disease association.

Methods: We extracted genes with evidence for gene-disease association from the Human Gene Mutation Database, OMIM, and ClinVar to build a comprehensive gene list of 6,145 genes. Read More

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Extracorporeal treatment for poisoning to beta-adrenergic antagonists: systematic review and recommendations from the EXTRIP workgroup.

Crit Care 2021 06 10;25(1):201. Epub 2021 Jun 10.

Research Center, CIUSSS du Nord-de-L'île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, University of Montreal, Montreal, QC, Canada.

Background: β-adrenergic antagonists (BAAs) are used to treat cardiovascular disease such as ischemic heart disease, congestive heart failure, dysrhythmias, and hypertension. Poisoning from BAAs can lead to severe morbidity and mortality. We aimed to determine the utility of extracorporeal treatments (ECTRs) in BAAs poisoning. Read More

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Prediction Of Shiftworker Alertness, Sleep, And Circadian Phase Using A Model Of Arousal Dynamics Constrained By Shift Schedules And Light Exposure.

Sleep 2021 Jun 10. Epub 2021 Jun 10.

The University of Sydney, School of Physics, Camperdown, Australia.

Study Objectives: The study aimed to, for the first time, (i) compare sleep, circadian phase, and alertness of Intensive Care Unit (ICU) nurses working rotating shifts with those predicted by a model of arousal dynamics; and (ii) investigate how different environmental constraints affect predictions and agreement with data.

Methods: The model was used to simulate individual sleep-wake cycles, urinary 6-sulphatoxymelatonin (aMT6s) profiles, subjective sleepiness on the Karolinska Sleepiness Scale (KSS), and performance on a Psychomotor Vigilance Task (PVT) of 21 ICU nurses working day, evening, and night shifts. Combinations of individual shift schedules, forced wake time before/after work and lighting, were used as inputs to the model. Read More

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Prevention of Perioperative Abdominal Migraine in a Patient Undergoing Spinal Fusion: A Case Report.

A A Pract 2021 Jun 10;15(6):e01484. Epub 2021 Jun 10.

Department of Neurosurgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona.

Abdominal migraine is a variant of migraine headaches characterized by episodic attacks of severe abdominal pain with migrainous features, including anorexia, nausea, vomiting, and pallor. It is more commonly diagnosed in children rather than adults. We describe a 74-year-old patient with progressively worsening back pain, severe neurogenic claudication, and a history of opioid-triggered abdominal migraine. Read More

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Diversity climate, trust, and turnover intentions: A multilevel dynamic system.

J Appl Psychol 2021 Jun 10. Epub 2021 Jun 10.

Pamplin College of Business, Virginia Tech.

Past research on employee trust and diversity climate is cross-sectional and often overlooks the distinction between overall unit climate and individual perceptions of climate. The current article addresses the complex relationship between trust and diversity climate, including directionality, evolution over time, multilevel characteristics, and influence on the critical outcome of turnover intentions. Using a novel, a multilevel analysis of cross-lagged panel data with latent interactions, we examined 6 years of data from 3,218 faculty members across 294 departments in a large U. Read More

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Molecular Weight of Hyaluronic Acid Has Major Influence on Its Efficacy and Safety for Viscosupplementation in Hip Osteoarthritis: A Systematic Review and Meta-Analysis.

Cartilage 2021 Jun 10:19476035211021903. Epub 2021 Jun 10.

Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung.

Background: This study aimed to compare the efficacy and safety of intra-articular hyaluronic acid (HA) injection with different molecular weights (MWs) for treating hip osteoarthritis (OA).

Methods: A systematic literature search for relevant studies was conducted in 3 electronic databases, including PubMed, BMJ Journals, and Cochrane Library, from inception to April 2020. Extracted outcomes included visual analogue scale (VAS) (1, 3, and 6 months), Lequesne index (3 and 6 months), and adverse effects. Read More

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An Evidence-Based Theory About PRO Use in Kidney Care: A Realist Synthesis.

Patient 2021 Jun 10. Epub 2021 Jun 10.

Sociology and Social Policy, University of Leeds, Leeds, UK.

Background: There is international interest on the use of patient-reported outcomes (PROs) in nephrology.

Objectives: Our objectives were to develop a kidney-specific program theory about use of PROs in nephrology that may enhance person-centered care, both at individual and aggregated levels of care, and to test and refine this theory through a systematic review of the empirical literature. Together, these objectives articulate what works or does not work, for whom, and why. Read More

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Large-scale open-source three-dimensional growth curves for clinical facial assessment and objective description of facial dysmorphism.

Sci Rep 2021 Jun 9;11(1):12175. Epub 2021 Jun 9.

Department of Human Genetics, KU Leuven, 3000, Leuven, Belgium.

Craniofacial dysmorphism is associated with thousands of genetic and environmental disorders. Delineation of salient facial characteristics can guide clinicians towards a correct clinical diagnosis and understanding the pathogenesis of the disorder. Abnormal facial shape might require craniofacial surgical intervention, with the restoration of normal shape an important surgical outcome. Read More

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Menopause impacts human brain structure, connectivity, energy metabolism, and amyloid-beta deposition.

Sci Rep 2021 Jun 9;11(1):10867. Epub 2021 Jun 9.

Departments of Pharmacology and Neurology, College of Medicine, University of Arizona, Tucson, AZ, USA.

All women undergo the menopause transition (MT), a neuro-endocrinological process that impacts aging trajectories of multiple organ systems including brain. The MT occurs over time and is characterized by clinically defined stages with specific neurological symptoms. Yet, little is known of how this process impacts the human brain. Read More

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Surgical and Radiological Management of Complicated Uterine Leiomyoma Aided by 3D Models in a Patient with Fibrodysplasia Ossificans Progressiva.

Am J Case Rep 2021 Jun 10;22:e931614. Epub 2021 Jun 10.

Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.

BACKGROUND Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disorder of the connective tissue. Over time, patients with FOP experience decreased range of motion in the joints and the formation of a second skeleton, limiting mobility. Patients with FOP are advised to avoid any unwarranted surgery owing to the risk of a heterotopic ossification flare-up. Read More

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Factors Associated With, and Mitigation Strategies for, Healthcare Disparities Faced by Patients With Headache Disorders.

Neurology 2021 Jun 9. Epub 2021 Jun 9.

Department of Neurology and Ophthalmology, Michigan State University College of Human Medicine, East Lansing, MI.

Objective: To review the contemporary issues of healthcare disparities in Headache Medicine with regard to race/ethnicity, socioeconomic status and geography and propose solutions for addressing these disparities.

Methods: An internet and PubMed search was performed and literature was reviewed for key concepts underpinning disparities in Headache Medicine. Content was refined to areas most salient to our goal of informing the provision of equitable care in headache treatment through discussions with this group of 16 experts from a range of headache subspecialties. Read More

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Building Back Better: Applying Lessons from the COVID-19 Pandemic to Expand Critical Information Access.

J Emerg Med 2021 Mar 26. Epub 2021 Mar 26.

Department of Emergency Medicine, University of California San Francisco, San Francisco, California.

Background: The Coronavirus disease 2019 (COVID-19) pandemic generated an unprecedented volume of evolving clinical guidelines that strained existing clinical information systems and necessitated rapid innovation in emergency departments (EDs).

Objectives: Our team aimed to harness new COVID-19-related reliance on digital clinical support tools to re-envision how all clinical guidelines are stored and accessed in our ED.

Methods: We used a design-thinking approach including empathizing, defining the problem, ideating, prototyping, and testing to develop a low-cost, homegrown clinical information hub: E*Drive. Read More

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Retrospective analysis of intracranial aneurysms after flow diverter treatment including color-coded imaging (syngo iFlow) as a predictor of aneurysm occlusion.

Interv Neuroradiol 2021 Jun 9:15910199211024056. Epub 2021 Jun 9.

Departments of Neuroradiology, Saarland University Hospital, Homburg/Saar, Germany.

Purpose: Flow Diverters (FD) have immensely extended the treatment of cerebral aneurysms in the past years. Complete aneurysm occlusion is a process that often takes a certain amount of time and is usually difficult to predict. Our aim was to investigate different syngo iFlow parameters in order to predict aneurysm occlusion. Read More

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