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Park SH, Pinto-Powell R, Thesen T, Lindqwister A, Levy J, Chacko R, Gonzalez D, Bridges C, Schwendt A, Byrum T, Fong J, Shasavari S, Hassanpour S. Preparing healthcare leaders of the digital age with an integrative artificial intelligence curriculum: a pilot study. Med Educ Online 2024; 29:2315684. [PMID: 38351737 PMCID: PMC10868429 DOI: 10.1080/10872981.2024.2315684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
Artificial intelligence (AI) is rapidly being introduced into the clinical workflow of many specialties. Despite the need to train physicians who understand the utility and implications of AI and mitigate a growing skills gap, no established consensus exists on how to best introduce AI concepts to medical students during preclinical training. This study examined the effectiveness of a pilot Digital Health Scholars (DHS) non-credit enrichment elective that paralleled the Dartmouth Geisel School of Medicine's first-year preclinical curriculum with a focus on introducing AI algorithms and their applications in the concurrently occurring systems-blocks. From September 2022 to March 2023, ten self-selected first-year students enrolled in the elective curriculum run in parallel with four existing curricular blocks (Immunology, Hematology, Cardiology, and Pulmonology). Each DHS block consisted of a journal club, a live-coding demonstration, and an integration session led by a researcher in that field. Students' confidence in explaining the content objectives (high-level knowledge, implications, and limitations of AI) was measured before and after each block and compared using Mann-Whitney U tests. Students reported significant increases in confidence in describing the content objectives after all four blocks (Immunology: U = 4.5, p = 0.030; Hematology: U = 1.0, p = 0.009; Cardiology: U = 4.0, p = 0.019; Pulmonology: U = 4.0, p = 0.030) as well as an average overall satisfaction level of 4.29/5 in rating the curriculum content. Our study demonstrates that a digital health enrichment elective that runs in parallel to an institution's preclinical curriculum and embeds AI concepts into relevant clinical topics can enhance students' confidence in describing the content objectives that pertain to high-level algorithmic understanding, implications, and limitations of the studied models. Building on this elective curricular design, further studies with a larger enrollment can help determine the most effective approach in preparing future physicians for the AI-enhanced clinical workflow.
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Affiliation(s)
- Soo Hwan Park
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Thomas Thesen
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Joshua Levy
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Rachael Chacko
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Connor Bridges
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Adam Schwendt
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Travis Byrum
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Justin Fong
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Zornoza Moreno M, Pérez-Martín J, Robles Mañueco M. Parents and teachers' perspectives on a school-located influenza vaccination program: A pilot study in the Region of Murcia, Spain. Hum Vaccin Immunother 2024; 20:2328406. [PMID: 38573783 PMCID: PMC10996829 DOI: 10.1080/21645515.2024.2328406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/06/2024] [Indexed: 04/06/2024] Open
Abstract
During the 2022-2023 season, the Region of Murcia (an autonomous community of Spain) introduced the influenza vaccination campaign in children aged 24-59 months with the live-attenuated influenza nasal spray vaccine. To expand coverage, a pilot study was conducted to include the 3- to 4-year population in 24 public schools. The aim of the study was to assess the experiences of parents and teachers involved in the project. This was a psychosocial qualitative study in which information was collected from a cohort of 23 parents and 17 teachers who attended three and two focus group sessions, respectively. A high degree of satisfaction with the school-located influenza vaccination program was consistently reported. The teachers reported creating a friendly environment and acting as companions to support children in the absence of their parents. They also considered the intranasal route, which avoids intramuscular puncture, as a facilitating element that turned the vaccination process into a kind of game. Parents emphasized the importance of vaccination to protect their children, and secondarily, to ensure protection of the family nucleus. Some parents who had their children already vaccinated in the health care center reported preference for the school setting, probably selecting this option in the future. The availability of school-based influenza vaccination promoted greater equity in accessing the vaccine and facilitated family reconciliation. To optimize coverage and minimize potential reluctance, providing the necessary information to parents both before and after vaccination was considered. School-located influenza vaccination was feasible and is a valuable strategy to be implemented in future campaigns.
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Affiliation(s)
- Matilde Zornoza Moreno
- Health Prevention and Protection Service, General Directorate of Public Health and Addictions, Health Council, Region de Murcia, Spain
| | - Jaime Pérez-Martín
- Health Prevention and Protection Service, General Directorate of Public Health and Addictions, Health Council, Region de Murcia, Spain
| | - Marta Robles Mañueco
- Immunotherapy and Vaccines Unit, AstraZeneca Farmacéutica Spain SA, Medical Department, Madrid, Spain
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Staubach P, Bilo B, Fluhr JW, Krause K, Kulthanan K, Salman A, Katelaris C, Bernstein JA, Maurer M, Mann C. UCOMB-real life data: treatment strategies for chronic urticaria patients with comorbidities. J DERMATOL TREAT 2024; 35:2329784. [PMID: 38508226 DOI: 10.1080/09546634.2024.2329784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND There is a lack of real-life safety data on treatment options for chronic urticaria in the presence of comedication and comorbidities. METHODS We present a single-center UCARE pilot study of 212 outpatients with chronic urticaria. Patients were divided into three groups according to different CU therapies according to international guidelines. RESULTS Of 212 patients, 108 (mean age 48.9 years, 71.3% female) had 59 comorbidities, including cardiovascular, autoimmune and malignant diseases. Patients were followed for a mean of 24.6 months (SD ± 21.3). Urticaria therapies were divided into three groups: A: 105 (97.2%) with omalizumab and 2nd generation antihistamines), B: 16 patients (14.8%): dual therapy with antihistamines and cyclosporine in 10 (9.3%), montelukast in five (4. 6%), dapsone in four (3.7%), hydroxychloroquine in one patient (0.9%), C: 12 (11.1%) patients received a third drug for 4.9 months (SD ± 3.2) and one quadruple therapy (2.1 months). 10 out of 12 (83.3%) patients received montelukast, two (16.7%) cyclosporine, two (16.7%) dapsone and one (8.3%) hydroxychloroquine as a third drug for chronic urticaria. CONCLUSIONS Combining treatment modalities for chronic urticaria and comorbidities are available and feasible with a good safety profile.
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Affiliation(s)
- Petra Staubach
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Benedikt Bilo
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Joachim W Fluhr
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology IFA, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Insitute for Translational Medicine and Pharmacology, ITMP Berlin, Immunology and Allergology IA, Berlin, Germany
| | - Karoline Krause
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology IFA, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Insitute for Translational Medicine and Pharmacology, ITMP Berlin, Immunology and Allergology IA, Berlin, Germany
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Andac Salman
- Department of Dermatology, Acıbadem University School of Medicine, Istanbul, Turkey
| | - Connie Katelaris
- Department of Medicine, Campbelltown Hospital and Western Sydney University Sydney, Campbelltown, Australia
| | - Jonathan A Bernstein
- Division of Rheumatology, Allergy and Immunology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marcus Maurer
- Urticaria Center of Reference and Excellence (UCARE), Institute of Allergology IFA, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Fraunhofer Insitute for Translational Medicine and Pharmacology, ITMP Berlin, Immunology and Allergology IA, Berlin, Germany
| | - Caroline Mann
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Hong JY, Shin SH, Koh YG, Seok J, Park KY. Efficacy and safety of a novel 785 nm picosecond neodymium-doped yttrium aluminum garnet laser for the treatment of facial benign pigmented lesions in Asian skin: a pilot study. J DERMATOL TREAT 2024; 35:2293640. [PMID: 38108131 DOI: 10.1080/09546634.2023.2293640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 12/05/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Benign pigmented lesions and a general uneven tone in people with skin of color are growing issues that have been presented to dermatologists. To the best of our knowledge, this is the first controlled study to examine the efficacy and safety of using the newly introduced 785 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) picosecond laser to treat facial benign pigmented lesions in Asian patients with diffractive lens array. MATERIALS AND METHODS A 785 nm Nd:YAG picosecond laser was used to treat 15 healthy female volunteers older than 18 years who had Fitzpatrick skin types II-IV and facial benign pigmented lesions. Each volunteer received five weekly treatments in dual modes. The clinical improvement was assessed by independent investigators and by objectively measuring the melanin index. RESULTS After the treatment, the melanin and erythema indices decreased, and the pigmented lesions showed clinical improvements. No serious adverse effects were observed during the study period. CONCLUSIONS A 785 nm Nd:YAG picosecond laser may be safe and effective in treating facial benign pigmented lesions in Asian skin.
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Affiliation(s)
- Ji Yeon Hong
- Department of Dermatology, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Sun Hye Shin
- Department of Dermatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Gue Koh
- Department of Dermatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joon Seok
- Department of Dermatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kui Young Park
- Department of Dermatology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Kim K, Kim HH, Joo JB, Kim OK, Park SW, Suh GH, Ro WB, Lee CM. Evaluation of the clinical usefulness of pancreatic alpha amylase as a novel biomarker in dogs with acute pancreatitis: a pilot study. Vet Q 2024; 44:1-7. [PMID: 38497337 PMCID: PMC10949834 DOI: 10.1080/01652176.2024.2326007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 02/10/2024] [Indexed: 03/19/2024] Open
Abstract
Pancreatic alpha amylase (P-AMY) is used as a biomarker of acute pancreatitis (AP) in human medicine. To our knowledge, there are no studies evaluating the usefulness of P-AMY in dogs with AP. In this study, we evaluated the diagnostic value of P-AMY, currently not verified in veterinary medicine. The AP group (n = 40) consisted of dogs with AP diagnosed using clinical signs and laboratory examinations, including abnormal canine pancreatic lipase (cPL) concentration, and compatible abdominal ultrasound examination at first presentation. Evaluation of the canine AP severity (CAPS) score was performed. The control group (n = 38) was composed of normal dogs without any abnormalities in clinical findings, blood exams or diagnostic imaging. The correlation of P-AMY with cPL was confirmed by Pearson's correlation analysis (r = 0.564, p < .001). The sensitivity and specificity for the most appropriate cut-off values of P-AMY were recorded similar to the values of DGGR. The dogs with AP and CAPS ≥11 had significantly higher serum P-AMY (p = .016) contrary to DGGR lipase and cPL. Furthermore, there was a significant difference in the median P-AMY dependent on the presence of systemic inflammatory response syndrome (p = .001). P-AMY showed similar level of diagnostic accuracy along with sensitivity and specificity compared to DGGR lipase. In addition, P-AMY showed a significant association with CAPS score, contrary to cPL and DGGR lipase. Along with other biomarkers associated with AP, P-AMY has the potential of usefulness as a supportive diagnostic and prognostic biomarker of AP in dogs.
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Affiliation(s)
- Keon Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Korea
| | - Hee-hong Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Korea
- Cool-pet Animal Hospital, Daegu, Korea
| | - Jae-Beom Joo
- Department of Veterinary Internal Medicine, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Korea
| | - Ock-Kyu Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Korea
| | - Sin-Wook Park
- Department of Veterinary Internal Medicine, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Korea
| | - Guk-Hyun Suh
- Department of Veterinary Internal Medicine, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Korea
| | - Woong-Bin Ro
- Department of Veterinary Internal Medicine, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Korea
| | - Chang-Min Lee
- Department of Veterinary Internal Medicine, College of Veterinary Medicine and BK21 FOUR program, Chonnam National University, Gwangju, Korea
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Acikgöz AS, Gök K, Tüten A, Kaya B, Hamzaoğlu K, Kolomuç Gayretli T, Malik E, Güralp O. Evaluation of serum levels of soluble vascular endothelial (sVE)-Cadherin in early- and late-onset preeclampsia serum sVE-Cadherin levels in preeclampsia. J Matern Fetal Neonatal Med 2024; 37:2326304. [PMID: 38499386 DOI: 10.1080/14767058.2024.2326304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
OBJECTIVE Endothelial dysfunction is a major feature of preeclampsia. sVE-cadherin plays a role in the preservation and regulation of the endothelial barrier. For that reason, to evaluation of sVE-cadherin may help elucidate the disease pathophysiology of preeclampsia. METHODS The sample size was calculated as a minimum of 46 pregnant women for each group based on serum sVE-Cadherin levels in a pilot study of 10 preeclamptic and 10 control groups. Hundred-twenty pregnancies complicated with early-onset (n = 60) and late-onset (n = 60) preeclampsia were compared with 120 gestational-age (GA)-matched (±1 week) uncomplicated pregnancies. The venous blood sampling was performed upon preeclampsia diagnosis prior to the onset of the labor in the preeclampsia group and the matching (±1 week) pregnancy week in the control group. Demographic and biochemical parameters were evaluated. RESULTS Mean serum sVE-Cadherin was significantly higher in women with EOPE compared to that of the GA-matched control group (5.86 ± 1.57 ng/mL vs. 2.28 ± 0.80 ng/mL, p < 0.001), in women with LOPE compared to that of the GA-matched control group (3.11 ± 0.97 ng/mL vs. 1.69 ± 0.87 ng/mL, p < 0.001), and in women with EOPE compared to that of LOPE group (5.86 ± 1.57 ng/mL vs. 3.11 ± 0.97 ng/mL, p < 0.001) after correction for GA. Serum sVE-Cadherin positively correlated with systolic and diastolic blood pressure and a negative correlation with gestational age at sampling. CONCLUSION The serum level of sVE-Cadherin was higher in women with preeclampsia than that of GA-matched healthy pregnant women, in women with EOPE compared to that of LOPE. sVE-Cadherin is an important marker in early-onset pre-eclampsia with severe clinical findings.
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Affiliation(s)
- Abdullah Serdar Acikgöz
- Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Koray Gök
- Department of Obstetrics and Gynecology, Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital, University of Health Sciences Turkey, Istanbul, Turkey
| | - Abdullah Tüten
- Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Barış Kaya
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Kübra Hamzaoğlu
- Department of Obstetrics and Gynecology, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Tuğba Kolomuç Gayretli
- Department of Obstetrics and Gynecology, Etlik Zubeyde Hanim Women's Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Eduard Malik
- Carl von Ossietzky Oldenburg University, University Hospital for Gynecology and Obstetrics, Oldenburg, Germany
| | - Onur Güralp
- Carl von Ossietzky Oldenburg University, University Hospital for Gynecology and Obstetrics, Oldenburg, Germany
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Brath MSG, Sahakyan M, Mark EB, Rasmussen HH, Østergaard LR, Frøkjær JB, Weinreich UM, Jørgensen ME. Ethnic differences in CT derived abdominal body composition measures: a comparative retrospect pilot study between European and Inuit study population. Int J Circumpolar Health 2024; 83:2312663. [PMID: 38314517 PMCID: PMC10846476 DOI: 10.1080/22423982.2024.2312663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/28/2024] [Indexed: 02/06/2024] Open
Abstract
Understanding ethnic variations in body composition is crucial for assessing health risks. Universal models may not suit all ethnicities, and there is limited data on the Inuit population. This study aimed to compare body composition between Inuit and European adults using computed tomography (CT) scans and to investigate the influence of demographics on these measurements. A retrospective analysis was conducted on 50 adults (29 Inuit and 21 European) who underwent standard trauma CT scans. Measurements focused on skeletal muscle index (SMI), various fat indices, and densities at the third lumbar vertebra level, analyzed using the Wilcoxon-Mann-Whitney test and multiple linear regression. Inuit women showed larger fat tissue indices and lower muscle and fat densities than European women. Differences in men were less pronouncehd, with only Intramuscular fat density being lower among Inuit men. Regression indicated that SMI was higher among men, and skeletal muscle density decreased with Inuit ethnicity and age, while visceral fat index was positively associated with age. This study suggests ethnic differences in body composition measures particularly among women, and indicates the need for Inuit-specific body composition models. It higlights the importance of further research into Inuit-specific body composition measurements for better health risk assessment.
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Affiliation(s)
- Mia Solholt Godthaab Brath
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
- Respiratory Research Aalborg, Reaal, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marina Sahakyan
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Esben Bolvig Mark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Mech-Sense, Department. of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Højgaard Rasmussen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Danish Nutrition Science Center, Department. of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
- Center for Nutrition and Intestinal Failure, Department. of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark
- The Dietitians and Nutritional Research Unit, EATEN, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Lasse Riis Østergaard
- Medical Informatics group, Department. of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Ulla Møller Weinreich
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
- Respiratory Research Aalborg, Reaal, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marit Eika Jørgensen
- Clinical Epidemiology, Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
- Steno Diabetes Center Greenland, Queen Ingrid’s Hospital, Nuuk, Greenland
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Chatzivasileiou P, Armeni E, Chedraui P, Kontou L, Augoulea A, Palaiologou A, Kaparos G, Panoulis K, Alexandrou A, Vlachos N, Lambrinoudaki I. Postmenopausal women with higher TSH values within the normal range present improved handgrip strength: a pilot study. Gynecol Endocrinol 2024; 40:2333432. [PMID: 38567465 DOI: 10.1080/09513590.2024.2333432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To evaluate the possible association between thyroid function within the euthyroid range and musculoskeletal parameters as well as body composition in a sample of postmenopausal women. METHODS This cross-sectional study included 96 postmenopausal women with serum thyroid-stimulating hormone (TSH) within the normal laboratory reference range. Fasting venous blood samples were obtained for biochemical/hormonal assessment. Bone status and body composition were measured using Dual Energy X-ray absorptiometry (DXA). Physical activity was quantified using the International Physical Activity Questionnaire (IPAQ) index. RESULTS Serum TSH correlated with handgrip strength (HGS, r-coefficient = 0.233, p = .025), and total body bone mineral density (BMD) T-score values (r-coefficient = 0.321, p = .003). HGS measures were associated with BMD (r-coefficient = 0.415, p < .001), with bone mineral content (BMC, r-coefficient = 0.427, p < .001), and lean mass (r-coefficient = 0.326, p = .003). Women with low muscle strength, defined as HGS < 16 kg, had lower TSH levels than women with normal muscle strength (low vs. normal muscle strength, ANCOVA 1.13 ± 0.49 mU/L vs. 1.60 ± 0.83 mU/L, p = 0.024) independently of age, BMD, percentage of body fat or absolute lean mass. Multivariable linear regression analysis showed that HGS values were associated with TSH measurements (β-coefficient = 0.246, p = .014) and BMD T-score values (β-coefficient = 0.306, p = .002). All models were adjusted for age, body mass index (BMI), vitamin D, low-density lipoprotein cholesterol, current smoking, physical activity, and homeostasis model assessment of insulin resistance. CONCLUSIONS In this sample of postmenopausal women, lower serum TSH values, within normal range, were associated with lower muscle strength compared to higher normal TSH values. Further research is needed to elucidate the significance of our preliminary findings.
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Affiliation(s)
- Panagiota Chatzivasileiou
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Eleni Armeni
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
- Royal Free Hospital, NHS Foundation Trust, University College London Medical School, London, UK
| | - Peter Chedraui
- Escuela de Posgrado en Salud, Universidad Espíritu Santo, Samborondón, Ecuador
| | - Loraina Kontou
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Areti Augoulea
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Anastasia Palaiologou
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - George Kaparos
- Biochemical Laboratory, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Konstantinos Panoulis
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Andreas Alexandrou
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Nikolaos Vlachos
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, Menopause Clinic, Aretaieio Hospital, University of Athens, Athens, Greece
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Edvinsson C, Björnsson O, Erlandsson L, Hansson SR. Predicting intensive care need in women with preeclampsia using machine learning - a pilot study. Hypertens Pregnancy 2024; 43:2312165. [PMID: 38385188 DOI: 10.1080/10641955.2024.2312165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/02/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Predicting severe preeclampsia with need for intensive care is challenging. To better predict high-risk pregnancies to prevent adverse outcomes such as eclampsia is still an unmet need worldwide. In this study we aimed to develop a prediction model for severe outcomes using routine biomarkers and clinical characteristics. METHODS We used machine learning models based on data from an intensive care cohort with severe preeclampsia (n=41) and a cohort of preeclampsia controls (n=40) with the objective to find patterns for severe disease not detectable with traditional logistic regression models. RESULTS The best model was generated by including the laboratory parameters aspartate aminotransferase (ASAT), uric acid and body mass index (BMI) with a cross-validation accuracy of 0.88 and an area under the curve (AUC) of 0.91. Our model was internally validated on a test-set where the accuracy was lower, 0.82, with an AUC of 0.85. CONCLUSION The clinical routine blood parameters ASAT and uric acid as well as BMI, were the parameters most indicative of severe disease. Aspartate aminotransferase reflects liver involvement, uric acid might be involved in several steps of the pathophysiologic process of preeclampsia, and obesity is a well-known risk factor for development of both severe and non-severe preeclampsia likely involving inflammatory pathways..[Figure: see text].
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Affiliation(s)
- Camilla Edvinsson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Division of Anaesthesia and Intensive Care, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - Ola Björnsson
- Division of Mathematical Statistics, Centre for Mathematical Sciences, Lund University, Lund, Sweden
- Department of Energy Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Lena Erlandsson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Stefan R Hansson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund/Malmö, Sweden
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Merenstein D, Tan T, Herbin Smith K. Exploratory Pilot Studies to Demonstrate Mechanisms of Preventing Antibiotic-Associated Diarrhea and the Role for Probiotics. Ann Fam Med 2024; 21:4766. [PMID: 38271205 PMCID: PMC10983260 DOI: 10.1370/afm.22.s1.4766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Context: Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host. One of the most common indications for probiotic treatment is the prevention of antibiotic-associated diarrhea (AAD). Unfortunately, many probiotic products used for AAD are not supported by rigorous independent research, and often results in non-evidence-based usage. Additionally, it is not clear when is the most appropriate time to take a probiotic when on an antibiotic course. Objectives: The primary aim is to determine the ability of BB-12 to impact antibiotic-induced reduction in short chain fatty acid concentration (SCFA), as reflected by the levels of acetate on day 14. Secondarily to determine the ability of BB-12 to impact antibiotic-induced disruption of the gut microbiota with 16S rDNA profiling, with the addition of the time variable of probiotic consumption. Study Design and Interventions: A five group randomized controlled trial, finished in December 2022, we are currently analyzing all the data, but will be finished much prior to NAPCRG. All participants were given a 7-day prescription for amoxicillin-clavulanic acid 875mg taken twice daily. One group received no other interventions. While the other participants were broken into 4 groups. Two groups consumed the yogurt intervention (either yogurt+probiotic or control yogurt) four hours after the antibiotic and two groups consumed the yogurt intervention (either yogurt+probiotic or control yogurt) concomitantly with antibiotics. This timing question is important, as it is unknown if the optimal time for patients to administer probiotics is concurrently with, or after four hours following antibiotic consumption. Setting: Capital Areal Primary Care Practice Based Research Network. Population Studied: 118 participants, ages 18-65 years, generally healthy. Outcome Measures: Change in SCFA among the five groups, microbiome reduced disruption and clinically diagnosed diarrhea. Results: Study is complete and analysis is underway. Should have full results by end of July 2023, much before NAPCRG. .
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11
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Suffoletto B, Lee CM, Mason M. A text message intervention aimed at nurturing peer outreach to help meet drinking limit goals: A remote pilot randomized trial in non-collegiate young adults. Addict Behav 2024; 154:108020. [PMID: 38552400 DOI: 10.1016/j.addbeh.2024.108020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 03/14/2024] [Accepted: 03/17/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE Scalable interventions attempting to nurture peer outreach to help young adults meet drinking limit goals remain under-developed. To address this gap, we developed ASPIRE, a text message intervention focused on coaching individuals to engage with close peers to assist them in meeting drinking limit goals. METHOD Non-collegiate young adults who had reported one or more heavy drinking days in the preceding month and were at least contemplating change were recruited through social media. Participants were randomly assigned to one of three 6-week text message interventions: Control, Goal Support, or ASPIRE. All groups completed baseline assessments and received weekly text message assessments on Thursdays and Sundays. Control and ASPIRE groups were prompted to complete web-based outcome assessments at 6- and 12-weeks. RESULTS We enrolled 92 young adults from 31 US states (65% female; 73% White). All groups had high text response rates but intervention usability was sub-optimal. Follow-up rates were 87% at 6-weeks and 79% at 12-weeks. Compared to Control, ASPIRE participants reported significantly more peer support and less peer pressure to drink. ASPIRE exhibited higher goal confidence compared to the Goal Support group. Using multiple imputation, there were no significant differences in drinking outcomes between groups. CONCLUSIONS Preliminary findings from this pilot study suggest that a text message intervention focused on nurturing peer outreach to help meet drinking limit goals holds promise in altering peer support and pressure as well as boosting drinking limit goal confidence. Design improvements are needed to reduce alcohol consumption.
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Affiliation(s)
| | - Christine M Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington
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12
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Aishwarya D, Nikhil P, Natesan S, Velayutham R, Peraman R. Development and validation of high-performance liquid chromatography-Orbitrap mass spectrometric method for quantification of NDMA in ranitidine drug products and evaluation of antioxidants as inhibitors of classical nitrosation reaction. Rapid Commun Mass Spectrom 2024; 38:e9747. [PMID: 38600640 DOI: 10.1002/rcm.9747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 01/09/2024] [Accepted: 03/04/2024] [Indexed: 04/12/2024]
Abstract
RATIONALE N-Nitroso dimethylamine (NDMA) is a mutagenic impurity detected in several ranitidine products. The amino functional group of ranitidine is a risk factor for classical nitrosation-induced NDMA formation in ranitidine drug products during storage conditions. The United States Food and Drug Administration (US FDA) recommended the use of antioxidants to control NDMA in drug products. Considering the need for sensitive analytics, a liquid chromatography/high-resolution mass spectrometry (LC-HRMS) method was developed and validated to detect NDMA in this pilot study to demonstrate the antioxidants as inhibitors of nitrosation reactions. METHODS The method, utilizing an EC-C18 column and tuned to atmospheric pressure chemical ionization/selected ion monitoring (APCI/SIM) mode, separated NDMA (m/z: 75.0553; tR: 3.71 min) and ranitidine (m/z: 315.1485; tR: 8.61 min). APCI mode exhibited four times higher sensitivity to NDMA than electrospray ionization (ESI) mode. Classical nitrosation of the dimethyl amino group of ranitidine was studied with sodium nitrite in solid pellets. Antioxidants (alpha-tocopherol, ascorbic acid, and trolox) were evaluated as NDMA attenuators in ranitidine pellets under vulnerable storage conditions. The developed method quantified NDMA levels in samples, extracted with methanol through vortex shaking for 45 min. RESULTS The method achieved a limit of detection (LOD) and limit of quantitation (LOQ) of 0.01 and 0.05 ng/mL, respectively, with linearity within 1-5000 ng/mL (R1: 0.9995). It demonstrated good intra-day and inter-day precision (% RSD [relative standard deviation]: <2) and accuracy (96.83%-101.72%). Nitrosation of ranitidine induced by nitrite was significant (p < 0.001; R2 = 0.9579) at various sodium nitrite levels. All antioxidants efficiently attenuated NDMA formation during ranitidine nitrosation. Ascorbic acid exhibited the highest NDMA attenuation (96.98%), followed by trolox (90.58%). This study recommends 1% ascorbic acid and trolox as potent NDMA attenuators in ranitidine drug products. CONCLUSIONS This study compared the effectiveness of antioxidants as NDMA attenuators in ranitidine under storage conditions susceptible to NDMA generation. The study concluded that ascorbic acid and trolox are potent inhibitors of NDMA formation and nitrosation attenuators in ranitidine drug products.
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Affiliation(s)
- Dande Aishwarya
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India
| | - Pallaprolu Nikhil
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India
| | - Subramanian Natesan
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research (NIPER), Kolkata, West Bengal, India
| | - Ravichandiran Velayutham
- Department of Natural Products, National Institute of Pharmaceutical Education and Research (NIPER), Kolkata, West Bengal, India
| | - Ramalingam Peraman
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, Bihar, India
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Jeong J, Lee Y, Han J, Kang E, Kim D, Kim KS, Kim EAR, Lee BS, Jung E. Mitochondrial DNA mutations in extremely preterm infants with bronchopulmonary dysplasia. Gene 2024; 910:148337. [PMID: 38432533 DOI: 10.1016/j.gene.2024.148337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
Bronchopulmonary dysplasia (BPD) is a serious chronic lung disease affecting extremely preterm infants. While mitochondrial dysfunction has been investigated in various medical conditions, limited research has explored mitochondrial DNA (mtDNA) gene mutations, specifically in BPD. This study aimed to evaluate mitochondrial mtDNA gene mutations in extremely preterm infants with BPD. In this prospective observational study, we enrolled a cohort of extremely preterm infants diagnosed with BPD. Clinical data were collected to provide comprehensive patient profiles. Peripheral blood mononuclear cells were isolated from whole-blood samples obtained within a defined timeframe. Subsequently, mtDNA extraction and sequencing using next-generation sequencing technology were performed to identify mtDNA gene mutations. Among the cohort of ten extremely preterm infants with BPD, mtDNA sequencing revealed the presence of mutations in seven patients, resulting in a total of twenty-one point mutations. Notably, many of these mutations were identified in loci associated with critical components of the respiratory chain complexes, vital for proper mitochondrial function and cellular energy production. This pilot study provides evidence of mtDNA point mutations in a subset of extremely preterm infants with BPD. These findings suggest a potential association between mitochondrial dysfunction and the pathogenesis of BPD. Further extensive investigations are warranted to unravel the mechanisms underlying mtDNA mutations in BPD.
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Affiliation(s)
- Jiyoon Jeong
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
| | - Yeonmi Lee
- Department of Convergence Medicine and Stem Cell Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea; Department of Biomedical Science, College of Life Science, CHA University, 335, Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Jongsuk Han
- Department of Convergence Medicine and Stem Cell Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea; Department of Biomedical Science, College of Life Science, CHA University, 335, Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Eunju Kang
- Department of Convergence Medicine and Stem Cell Center, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea; Department of Biomedical Science, College of Life Science, CHA University, 335, Pangyo-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of Korea.
| | - Deokhoon Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
| | - Ki-Soo Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
| | - Ellen Ai-Rhan Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
| | - Byong Sop Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
| | - Euiseok Jung
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea.
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Chou WY, Shieh JY, Weng WC, Lin CW. Quantifying lower limb muscle stiffness in typically developing children and adolescents using acoustic radiation force impulse shear wave elastography (ARFI/SWE)-a pilot study. Skeletal Radiol 2024; 53:1111-1118. [PMID: 38057435 DOI: 10.1007/s00256-023-04534-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To investigate and quantify age-related changes in lower limb muscle stiffness in typically developing children and adolescents using acoustic radiation force impulse shear wave elastography. MATERIALS AND METHODS Shear wave velocities of bilateral rectus femoris, tibialis anterior, and medial gastrocnemius muscles at rest were obtained in typically developing children and adolescents aged 3 to 18 years. The participants were classified into three age groups: Group 1 (children), 3 to 7 years old; Group 2, 8 to 12 (pre-adolescent); and Group 3 (adolescent), 13 to 18. The shear wave velocities of muscle were compared across the three age groups, as well as compared between right- and left-side limbs. The correlation between shear wave velocities and body weight or body mass index was assessed. RESULTS Of the 47 participants, 21 were in Group 1, 17 in Group 2, and 9 in Group 3. There were no significant differences among the three age groups' shear wave velocities of bilateral lower limb muscles, and no significant differences between right and left sides. There was no correlation between muscle stiffness and body weight or body mass index. CONCLUSION The present pilot study applied acoustic radiation force impulse shear wave elastography to quantify lower limb muscle stiffness in typically developing children and adolescents aged 3 to 18 years, suggesting no marked change in muscle stiffness occurs as they develop.
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Affiliation(s)
- Wen-Yu Chou
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1 Changde St., Taipei City, 100229, Taiwan
| | - Jeng-Yi Shieh
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1 Changde St., Taipei City, 100229, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, and College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pediatric Neurology, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Chia-Wei Lin
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, No.1 Changde St., Taipei City, 100229, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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15
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Gökçe Y, Akman F, Kılıçoğlu Ö, Üncü YA, Özdoğan H. A pilot study of diabetes effects on radiation attenuation characteristics of tibia and femur of rats. Appl Radiat Isot 2024; 208:111296. [PMID: 38508065 DOI: 10.1016/j.apradiso.2024.111296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/26/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024]
Abstract
This study aimed to investigate the effect of diabetes on radiation attenuation parameters of the femur and tibia of rats using Monte Carlo Simulations. First, control and diabetic rats were identified and tibias and femurs were removed. Then, the elemental ratios of the bones obtained were calculated using EDS (Energy Dissipative X-ray Spectroscopy). Therefore, radiation permeability properties of control and diabetic bones were simulated by using the content ratios in the bones in MCNP6 (Monte Carlo N-Particle) and PHITS (Particle and Heavy Ion Transport code System) 3.22 and Stopping and Range of Ions in Matter (SRIM) simulation codes. Attenuation coefficient results were compared with the NIST database via XCOM. Although differences in absorption coefficients are observed at low energies, these differences disappear as the energy increases.
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Affiliation(s)
- Yasin Gökçe
- Harran University Department of Biophysics, Şanlıurfa, Turkiye
| | - Ferdi Akman
- Bingöl University, Vocational School of Social Sciences, Department of Property Protection and Security, Program of Occupational Health and Safety, 12000, Bingöl, Turkiye
| | - Özge Kılıçoğlu
- Vocational School of Health Services, Marmara University, Kartal, Istanbul, Turkiye
| | - Yiğit Ali Üncü
- Akdeniz University, Vocational School of Technical Sciences, Department of Biomedical Equipment Technology, 07070, Antalya, Turkiye
| | - Hasan Özdoğan
- Antalya Bilim University, Vocational School of Health Services, Department of Medical Imaging Techniques, 07190, Antalya, Turkiye.
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Berre VO, Knutstad U, Jensen KT. Perspectives on self-directed learning in bioscience in nurse education - An integrative review. Nurse Education Today 2024; 137:106158. [PMID: 38493586 DOI: 10.1016/j.nedt.2024.106158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/28/2024] [Accepted: 03/10/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES There is a lack of synthesized knowledge on nursing students self-directed learning in bioscience and how to best support students' learning in this subject. The purpose of this integrative review is to synthesize current literature on perspectives on self-directed learning among nursing students studying bioscience to guide further research aiming to support students' learning more effectively. METHODS An integrative review in line with Whittemore & Knafl's modified framework containing five stages: problem identification, literature search, data evaluation, data analysis and presentation. A structured literature search was undertaken in the Web of Science, ERIC, Medline and CINAHL databases from November 2022 to January 2023. The inclusion criteria were nursing students enrolled in a bachelor programme, research addressing activities intended for learning bioscience, in addition to formal taught lectures and perspectives on self-directed learning in natural science subjects within nurse education such as views, actions, activities, habits and attitudes. Exclusion criteria were students in other education programs, research in formal learning contexts, and self-directed learning in other subjects than natural science subjects. Rigour of each included source was assessed using Whittemore & Knafl's suggested 2-point scale (high or low). A constant comparison method was used to synthesize results. RESULTS Of the initial 1143 sources, 12 articles were included after abstract and full-text screening: one pilot study for randomized controlled trial, one qualitative study, two mixed methods studies and eight quantitative studies. The sample size was from 23 to 563 participants. DISCUSSION This review identifies self-directed learning in bioscience understood as a continuum of teacher-directedness and self-directedness rather than as distinguished orientations. There seem to be no consistent definition of self-directed learning in bioscience, yet descriptions commonly imply metacognitive learning approaches. Nursing students value digital learning resources, yet technology might be secondary to the skill of self-directed learning.
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Ostrea MC, Rosales RL, Joya-Tanglao M. Efficacy and safety of apomorphine pump infusion in Filipino patients insufficiently controlled on oral anti-Parkinson medications: an open-label, pilot study. Int J Neurosci 2024; 134:131-136. [PMID: 35722686 DOI: 10.1080/00207454.2022.2090352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Apomorphine hydrochloride is used in the management of advanced Parkinson disease (PD), either as a rescue medication for off periods during levodopa therapy or as a maintenance pump medication. This is the first study to describe the effects of apomorphine in Filipino patients with PD. OBJECTIVE To evaluate the safety and efficacy of apomorphine ampules (APO-go®) pump infusion in the treatment of motor fluctuations in patients inadequately controlled on oral anti-Parkinson medications. METHODS Patients diagnosed with PD who developed motor fluctuations with levodopa were evaluated at baseline and at the end of the study using the Modified Hoehn and Yahr (H&Y) Scale, the Unified Parkinson's Disease Rating Scale (UPDRS) and the Abnormal Involuntary Movement Scale (AIMS). After initial assessment, patients were administered 20 ampules of apomorphine hydrochloride 10 mg/mL by infusion pump over 20 days. Intention-to-treat (ITT) analysis included all patients who completed at least one posttreatment assessment. Motor disability based on modified H&Y scores, motor function and complications of therapy pre- and posttreatment were compared using Wilcoxon Signed Rank test. Chi-squared test was used to compare outcomes by age and sex. Frequencies of adverse reactions were recorded to evaluate the tolerability of the medication. RESULTS Ten patients (mean age 63 ± 9.7 years), 3 male and 7 female, were enrolled in the study. Patients were given apomorphine for at most 16 days. The doses used were 2.5 mg/0.50 mL (n = 2), 3 mg/0.60 mL (n = 6), 4 mg/0.80 mL (n = 1) and 7 mg/1.40 mL (n = 1). After obtaining the threshold dose, two patients discontinued treatment. Eight of nine patients showed significant improvement in H&Y scores after treatment (p < 0.017). There was marked improvement after 10 days of treatment in at least five of 10 patients in terms of motor function using UPDRS, which included tremor (p < 0.034), rigidity (p < 0.002), facial expression (p < 0.014), finger taps (p < 0.008), foot taps (p < 0.014) and gait (p < 0.006). Significant changes from pre- to posttreatment scores in the frequency of dyskinesias (p < 0.010) and dystonia (p < 0.025) were observed. Nine focus areas of AIMS showed significant improvements in the muscles of facial expression (p < 0.020), upper (p < 0.016) and lower extremities (p < 0.010), incapacitation by abnormal movement (p < 0.010) and patients' awareness of abnormal movements (p < 0.039). Six patients experienced adverse events, none of which were related to the study drug. CONCLUSION Apomorphine hydrochloride pump infusion therapy is potentially effective and safe in the treatment of motor fluctuations in Filipino patients with PD. This pilot study springboards safe engagements of Filipino PD patients in multicenter, large-scale trials.
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Affiliation(s)
- Marc C Ostrea
- Center for Neuro-diagnostic and Therapeutic Services, Metropolitan Medical Center, Manila, Philippines
| | - Raymond L Rosales
- Center for Neuro-diagnostic and Therapeutic Services, Metropolitan Medical Center, Manila, Philippines
- Research Center for Health Sciences, Faculty of Medicine and Surgery, University of Santo Tomas, Manila, Philippines
- Saint Luke's Medical Centre, Institute for Neurosciences, Quezon City, Philippines
| | - Michelle Joya-Tanglao
- Center for Neuro-diagnostic and Therapeutic Services, Metropolitan Medical Center, Manila, Philippines
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Botello-Marabotto M, Martínez-Bisbal MC, Pinazo-Durán MD, Martínez-Máñez R. Tear metabolomics for the diagnosis of primary open-angle glaucoma. Talanta 2024; 273:125826. [PMID: 38479028 DOI: 10.1016/j.talanta.2024.125826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 04/09/2024]
Abstract
Primary Open-Angle Glaucoma (POAG) is the most prevalent glaucoma type, and the leading cause of irreversible visual impairment and blindness worldwide. Identification of early POAG biomarkers is of enormous value, as there is not an effective treatment for the glaucomatous optic nerve degeneration (OND). In this pilot study, a metabolomic analysis, by using proton (1H) nuclear magnetic resonance (NMR) spectroscopy was conducted in tears, in order to determine the changes of specific metabolites in the initial glaucoma eyes and to discover potential diagnostic biomarkers. A classification model, based on the metabolomic fingerprint in tears was generated as a non-invasive tool to support the preclinical and clinical POAG diagnosis. 1H NMR spectra were acquired from 30 tear samples corresponding to the POAG group (n = 11) and the control group (n = 19). Data were analysed by multivariate statistics (partial least squares-discriminant analysis: PLS-DA) to determine a model capable of differentiating between groups. The whole data set was split into calibration (65%)/validation (35%), to test the performance and the ability for glaucoma discrimination. The calculated PLS-DA model showed an area under the curve (AUC) of 1, as well as a sensitivity of 100% and a specificity of 83.3% to distinguish POAG group versus control group tear data. This model included 11 metabolites, potential biomarkers of the disease. When comparing the study groups, a decrease in the tear concentration of phenylalanine, phenylacetate, leucine, n-acetylated compounds, formic acid, and uridine, was found in the POAG group. Moreover, an increase in the tear concentration of taurine, glycine, urea, glucose, and unsaturated fatty acids was observed in the POAG group. These results highlight the potential of tear metabolomics by 1H NMR spectroscopy as a non-invasive approach to support early POAG diagnosis and in order to prevent visual loss.
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Affiliation(s)
- Marina Botello-Marabotto
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València - Universitat de València, Valencia, Spain; Unidad Mixta de Investigación en Nanomedicina y Sensores, Instituto de Investigación Sanitaria La Fe (IISLAFE) - Universitat Politècnica de València, Valencia, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Spain
| | - M Carmen Martínez-Bisbal
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València - Universitat de València, Valencia, Spain; Unidad Mixta de Investigación en Nanomedicina y Sensores, Instituto de Investigación Sanitaria La Fe (IISLAFE) - Universitat Politècnica de València, Valencia, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Spain; Departamento de Química Física, Universitat de València, Valencia, Spain.
| | - M Dolores Pinazo-Durán
- Ophthalmic Research Unit "Santiago Grisolia"/FISABIO, Valencia, Spain; Cellular and Molecular Ophthalmobiology Research Group at the University of Valencia, Valencia, Spain; Spanish Net of Inflammatory Research (REI-RICORS: RD21/0002/0032) Institute of Health Carlos III, Madrid, Spain
| | - Ramón Martínez-Máñez
- Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València - Universitat de València, Valencia, Spain; Unidad Mixta de Investigación en Nanomedicina y Sensores, Instituto de Investigación Sanitaria La Fe (IISLAFE) - Universitat Politècnica de València, Valencia, Spain; CIBER de Bioingeniería, Biomateriales y Nanomedicina, Instituto de Salud Carlos III, Spain; Departamento de Química, Universitat Politècnica de València, Valencia, Spain; Unidad Mixta UPV-CIPF de Investigación en Mecanismos de Enfermedades y Nanomedicina, València, Universitat Politècnica de València, Centro de Investigación Príncipe Felipe, Valencia, Spain
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Thai M, Nair AU, Klimes-Dougan B, Albott CS, Silamongkol T, Corkrum M, Hill D, Roemer JW, Lewis CP, Croarkin PE, Lim KO, Widge AS, Nahas Z, Eberly LE, Cullen KR. Deep transcranial magnetic stimulation for adolescents with treatment-resistant depression: A preliminary dose-finding study exploring safety and clinical effectiveness. J Affect Disord 2024; 354:589-600. [PMID: 38484878 DOI: 10.1016/j.jad.2024.03.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Transcranial magnetic stimulation (TMS) is an intervention for treatment-resistant depression (TRD) that modulates neural activity. Deep TMS (dTMS) can target not only cortical but also deeper limbic structures implicated in depression. Although TMS has demonstrated safety in adolescents, dTMS has yet to be applied to adolescent TRD. OBJECTIVE/HYPOTHESIS This pilot study evaluated the safety, tolerability, and clinical effects of dTMS in adolescents with TRD. We hypothesized dTMS would be safe, tolerable, and efficacious for adolescent TRD. METHODS 15 adolescents with TRD (Age, years: M = 16.4, SD = 1.42) completed a six-week daily dTMS protocol targeting the left dorsolateral prefrontal cortex (BrainsWay H1 coil, 30 sessions, 10 Hz, 3.6 s train duration, 20s inter-train interval, 55 trains; 1980 total pulses per session, 80 % to 120 % of motor threshold). Participants completed clinical, safety, and neurocognitive assessments before and after treatment. The primary outcome was depression symptom severity measured by the Children's Depression Rating Scale-Revised (CDRS-R). RESULTS 14 out of 15 participants completed the dTMS treatments. One participant experienced a convulsive syncope; the other participants only experienced mild side effects (e.g., headaches). There were no serious adverse events and minimal to no change in cognitive performance. Depression symptom severity significantly improved pre- to post-treatment and decreased to a clinically significant degree after 10 treatment sessions. Six participants met criteria for treatment response. LIMITATIONS Main limitations include a small sample size and open-label design. CONCLUSIONS These findings provide preliminary evidence that dTMS may be tolerable and associated with clinical improvement in adolescent TRD.
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Affiliation(s)
- Michelle Thai
- Department of Psychology, University of Minnesota, Twin Cities, MN, United States of America; Center for Depression, Anxiety, and Stress Research, McLean Hospital, Belmont, MA, United States of America; Department of Psychiatry, Harvard Medical School, United States of America.
| | - Aparna U Nair
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Bonnie Klimes-Dougan
- Department of Psychology, University of Minnesota, Twin Cities, MN, United States of America
| | - C Sophia Albott
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Thanharat Silamongkol
- Graduate School of Applied and Professional Psychology, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States of America
| | - Michelle Corkrum
- Columbia University Medical Center, New York, NY, United States of America
| | - Dawson Hill
- University of Michigan Medical School, Ann Arbor, MI, United States of America
| | - Justin W Roemer
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Charles P Lewis
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States of America
| | - Kelvin O Lim
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Alik S Widge
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Ziad Nahas
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
| | - Lynn E Eberly
- Division of Biostatistics, School of Public Health, University of Minnesota, United States of America
| | - Kathryn R Cullen
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, United States of America
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Barnason S, Miller JN, Schuelke S, Miller JJ, Kupzyk K. Self-management intervention for patients following hospitalization for acute exacerbation of chronic obstructive pulmonary disease (AECOPD): A pilot randomized controlled trial. Nurs Health Sci 2024; 26:e13114. [PMID: 38566419 DOI: 10.1111/nhs.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
The purpose of this study was to evaluate the handoff guidance (HG) self-management intervention for multimorbid chronic obstructive pulmonary disease (COPD) patients following hospitalization for acute exacerbation of COPD (AECOPD) using HG self-management intervention compared to a control group on COPD self-management outcomes (self-care, self-efficacy, health engagement) and assess feasibility, acceptability, and healthcare utilization. A randomized pilot study used a 2-group with repeated measures design. Adults with COPD who had been hospitalized for AECOPD were recruited. After discharge, the HG self-management intervention employed health coaching delivered at: 1-3, 10-12, and 20-22 days after hospital discharge. Follow-up data collected was collected at 1-3, 10-12, 20-22, 30, 60, and 90 days after hospital discharge. A total of 29 subjects participated, with a mean age of 66 (+8.7) years old, the majority were females (n = 18). Intervention participants reported the acceptability of the HG self-management intervention. Participants in both groups continued to report COPD symptoms after discharge, which decreased over time, although not significantly different by group. The use of COPD maintenance, monitoring, and management behaviors was higher in the treatment group, although not significantly different.
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Affiliation(s)
- Susan Barnason
- University of Nebraska Medical Center College of Nursing, Lincoln Division, Omaha, Nebraska, USA
| | - Jennifer N Miller
- University of Nebraska Medical Center College of Nursing, Lincoln Division, Omaha, Nebraska, USA
| | - Sue Schuelke
- University of Nebraska Medical Center College of Nursing, Lincoln Division, Omaha, Nebraska, USA
| | - Jessica J Miller
- University of Nebraska Medical Center College of Nursing, Lincoln Division, Omaha, Nebraska, USA
| | - Kevin Kupzyk
- University of Nebraska Medical Center College of Nursing, Omaha Division, Omaha, Nebraska, USA
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21
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Jallouli S, Ghroubi S, Dhia IB, Yahia A, Elleuch MH, Sakka S, Mhiri C, Hammouda O. Effect of melatonin intake on postural balance, functional mobility and fall risk in persons with multiple sclerosis: a pilot study. Int J Neurosci 2024; 134:137-147. [PMID: 35708140 DOI: 10.1080/00207454.2022.2090353] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/03/2022] [Indexed: 10/18/2022]
Abstract
AIM To assess the safety and the effect of a nocturnal melatonin (MEL) ingestion on postural balance, functional mobility and fall risk the following morning in adults with multiple sclerosis (MS). METHODS Fourteen adults with relapsing-remitting MS (RR-MS) (28.36 ± 6.81 years) were evaluated before and after nocturnal ingestion of MEL (6 mg) or placebo (PLA). Evaluations included a posturographic test of static bipedal postural balance with dual-task in eyes open (EO) and eyes closed conditions, and a clinical test of unipedal balance. The physical performance tests were: Timed Up and Go test (TUGT) (mobility), Four Square Step Test (FSST) (fall risk), and Timed 25-foot walk test (T25FWT) (walking speed). Cognitive performance [Montreal Cognitive Assessment (MoCA) and Simple Reaction Time (SRT) tests] and sleep quality [Spiegel's sleep questionnaire (SSQ)] were also assessed. RESULTS In EO condition, MEL decreased the posturographic parameters [center of pressure (CoP) sway area (CoPAr), CoP path length (CoPL) and CoPL in the mediolateral axis (CoPLX)] more than PLA by 15.82% (p = 0.0006), 12.48% (p = 0.0004) and 14.25% (p = 0.0002), respectively. Durations of TUGT and FSST decreased following MEL session more than the PLA one by 14.52% (p = 0.017) and 19.85% (p = 0.0006), respectively. MEL increased the unipedal stance time, SSQ and MoCA scores more than PLA by 49.81% (p = 0.04), 32.21% (p = 0.004) and 11.87% (p = 0.008), respectively. CONCLUSION This pilot study showed that acute nocturnal MEL ingestion seems to be safe for enhancing postural balance, fun mobility and fall risk in RR-MS adults probably through improving sleep quality and cognitive function.
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Affiliation(s)
- Sonda Jallouli
- Research laboratory: Evaluation and Management of Musculoskeletal System Pathologies, LR20ES09, Faculty of Medicine, University of Sfax, Sfax, Tunisia
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Sameh Ghroubi
- Research laboratory: Evaluation and Management of Musculoskeletal System Pathologies, LR20ES09, Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Department of Physical Medicine and Functional Rehabilitation, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imen Ben Dhia
- Research laboratory: Evaluation and Management of Musculoskeletal System Pathologies, LR20ES09, Faculty of Medicine, University of Sfax, Sfax, Tunisia
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, Tunisia
| | - Abdelmoneem Yahia
- Research laboratory: Evaluation and Management of Musculoskeletal System Pathologies, LR20ES09, Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Department of Physical Medicine and Functional Rehabilitation, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mohamed Habib Elleuch
- Research laboratory: Evaluation and Management of Musculoskeletal System Pathologies, LR20ES09, Faculty of Medicine, University of Sfax, Sfax, Tunisia
- Department of Physical Medicine and Functional Rehabilitation, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Salma Sakka
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR12SP19), Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
| | - Chokri Mhiri
- Laboratory of Neurogenetics, Parkinson's Disease and Cerebrovascular Disease (LR12SP19), Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
| | - Omar Hammouda
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), Paris Nanterre University, Nanterre, France
- Research Laboratory, Molecular Bases of Human Pathology, LR19ES13, Faculty of Medicine, University of Sfax, Sfax, Tunisia
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22
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Palatine E, Phillips ML, Soehner AM. The effect of slow wave sleep deprivation on mood in adolescents with depressive symptoms: A pilot study. J Affect Disord 2024; 354:347-355. [PMID: 38479512 DOI: 10.1016/j.jad.2024.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/13/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND There is an urgent need for safe, rapid-acting treatment strategies for adolescent depression. In depressed adults, slow wave sleep deprivation (SWSD) improved next-day mood without disrupting sleep duration, but SWSD has not been tested in adolescents. In a pilot study, the aim was to assess the effect of SWSD on sleep physiology and mood outcomes (depression, rumination, anhedonia) among adolescents with depressive symptoms. METHODS Sixteen adolescents (17.44 ± 1.46 yr, 12 female) completed three nights of polysomnographic sleep recording: Baseline, SWSD, and Recovery nights. Acoustic stimulation (tones of random pitch, duration, and volume) suppressed slow wave sleep (SWS) in real-time during SWSD. After each night, depression, rumination, and anhedonia severity were assessed. RESULTS SWSD successfully suppressed SWS, increased N2, and had minimal impact on Rapid Eye Movement (REM), nocturnal awakenings, and total sleep time. While SWSD did not improve depression or anhedonia severity overall, lower baseline non-REM alpha activity and greater SWS rebound during recovery sleep correlated with SWSD-related reduction in clinician-rated depression severity. Next-day rumination severity decreased after SWSD, with sustained improvements following recovery sleep. However, rumination improvement was not associated with SWS suppression, but rather reduction in total sleep time and REM in exploratory correlation models. LIMITATIONS Small sample size and large proportion of females. CONCLUSION SWSD did not improve depression in adolescents overall but a subset with low non-REM alpha activity and intact homeostatic sleep regulation may benefit from this approach. Findings from this pilot study also suggest that partial sleep deprivation may be a beneficial therapeutic strategy for rumination in adolescents.
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Affiliation(s)
- Elise Palatine
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Adriane M Soehner
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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23
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Quester R, Björck S, Manhem K, Nåtman J, Andersson S, Hjerpe P. Improving cardiovascular control in a hypertensive population in primary care. Results from a staff training intervention. Scand J Prim Health Care 2024; 42:347-354. [PMID: 38456742 PMCID: PMC11003316 DOI: 10.1080/02813432.2024.2326470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE A pilot study to evaluate a staff training intervention implementing a nurse-led hypertension care model. DESIGN AND SETTING Clinical and laboratory data from all primary care centres (PCCs) in the Swedish region Västra Götaland (VGR), retrieved from regional registers. Intervention started 2018 in 11 PCCs. A total of 190 PCCs served as controls. Change from baseline was assessed 2 years after start of intervention. INTERVENTION Training of selected personnel, primarily in drug choice, team-based care, measurement techniques, and use of standardized medical treatment protocols. PATIENTS Hypertensive patients without diabetes or ischemic heart disease were included. The intervention and control groups contained approximately 10,000 and 145,000 individuals, respectively. MAIN OUTCOME MEASURES Blood pressure (BP) <140/90 mmHg, LDL-cholesterol (LDL-C) <3.0 mmol/L, BP ending on -0 mmHg (digit preference, an indirect sign of manual measuring technique), choice of antihypertensive drugs, cholesterol lowering therapy and attendance patterns were measured. RESULTS In the intervention group, the percentage of patients reaching the BP target did not change significantly, 56%-61% (control 50%-52%), non-significant. However, the percentage of patients with LDL-C < 3.0 mmol/L increased from 34%-40% (control 36%-36%), p = .043, and digit preference decreased, 39%-27% (control 41%-35%), p = 0.000. The number of antihypertensive drugs was constant, 1.63 - 1.64 (control 1.62 - 1.62), non-significant, but drug choice changed in line with recommendations. CONCLUSION Although this primary care intervention based on staff training failed to improve BP control, it resulted in improved cardiovascular control by improved cholesterol lowering treatment.
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Affiliation(s)
- Rebecka Quester
- Närhälsan Bollebygd Health Care Centre, Bollebygd, Sweden
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Karin Manhem
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Emergency Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Per Hjerpe
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
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24
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Germano DB, Silveira ALPA, Kim YJ, do Amaral JB, Shio MT, da Silva Nali LH, Dos Santos Ferreira CE, Miyahira A, Fonseca FAH, Bachi ALL, Pallos D, França CN. Expression of monocyte chemokine receptors in diabetes after non-surgical periodontal treatment: A pilot study. Cytokine 2024; 178:156579. [PMID: 38471419 DOI: 10.1016/j.cyto.2024.156579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/29/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024]
Abstract
The aim of this study was to evaluate the effect of non-surgical periodontal treatment in the expression of chemokine receptors, in individuals with Periodontitis, associated or not with Diabetes. Pilot study, which included patients (n = 45) with Periodontitis, associated (n = 25) or not (n = 20) with Diabetes, submitted to the non-surgical periodontal treatment for one month. The expression of chemokine receptors CCR2, CCR5, and CX3CR1 at the mRNA level was evaluated in the peripheral mononuclear cells, as well as the expression of these receptors at the protein level was verified in monocyte subtypes (classical, intermediate, and non-classical monocytes). There was higher expression of CCR2 and CCR5 receptors at the initial visit in the group with Diabetes, with no differences for CX3CR1 (p = 0.002; p = 0.018, and p = 0.896, respectively), without differences after treatment. There was higher expression of CCR2 and CCR5 proteins in the group with Diabetes at the initial visit for classical, intermediate, and nonclassical monocytes, with no differences for CX3CR1 (CCR2: p = 0.004; p = 0.026; p = 0.024; CCR5: 0.045; p = 0.045; p = 0.013; CX3CR1: p = 0.424; p = 0.944; p = 0.392, respectively), without differences after the end of treatment. Concerning each group separately, there were reductions in the expression of CCR2 as well as CCR5 in classical, intermediate, and nonclassical monocytes, and reduction of CX3CR1 in classical monocytes after treatment in the group with Diabetes (p = 0.003; p = 0.006; p = 0.039; p = 0.007; p = 0.006; p = 0.004; p = 0.019, respectively), without differences in the group without Diabetes. The expression of the chemokine receptors CCR2 and CCR5, in patients with Periodontitis associated with Diabetes, is favorably modified after the end of the non-surgical periodontal treatment.
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Affiliation(s)
| | | | - Yeon Jung Kim
- Odontology Post Graduation, Santo Amaro University, Sao Paulo, Brazil
| | - Jônatas Bussador do Amaral
- Federal University of Sao Paulo, ENT Research Laboratory, Otorhinolaryngology-Head and Neck Surgery Department, Sao Paulo, Brazil
| | - Marina Tiemi Shio
- Health Sciences Post Graduation, Santo Amaro University, Sao Paulo, Brazil
| | | | | | | | | | | | - Débora Pallos
- Odontology Post Graduation, Santo Amaro University, Sao Paulo, Brazil.
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25
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Hong S, Choi Y, Lee MB, Rhee HY, Park S, Ryu CW, Cho AR, Kwon OI, Jahng GH. Increased extra-neurite conductivity of brain in patients with Alzheimer's disease: A pilot study. Psychiatry Res Neuroimaging 2024; 340:111807. [PMID: 38520873 DOI: 10.1016/j.pscychresns.2024.111807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/31/2024] [Accepted: 03/03/2024] [Indexed: 03/25/2024]
Abstract
The objectives of this study were to investigate how the extra-neurite conductivity (EC) and intra-neurite conductivity (IC) were reflected in Alzheimer's disease (AD) patients compared with old cognitively normal (CN) people and patients with amnestic mild cognitive impairment (MCI) and to evaluate the association between those conductivity values and cognitive decline. To do this, high-frequency conductivity (HFC) at the Larmor frequency was obtained using MRI-based electrical property tomography (MREPT) and was decomposed into EC and IC using information of multi-shell multi-gradient direction diffusion tensor images. This prospective single-center study included 20 patients with mild or moderate AD, 25 patients with amnestic MCI, and 21 old CN participants. After decomposing EC and IC from HFC for all participants, we performed voxel-based and regions-of-interest analyses to compare conductivity between the three participant groups and to evaluate the association with either age or the Mini-Mental State Examination (MMSE) scores. We found increased EC in AD compared to CN and MCI. EC was significantly negatively associated with MMSE scores in the insula, and middle temporal gyrus. EC might be used as an imaging biomarker for helping to monitor cognitive function.
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Affiliation(s)
- Seowon Hong
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea
| | - Yunjeong Choi
- Department of Biomedical Engineering, Undergraduate School, College of Electronics and Information, Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin-si, Gyeonggi-do 17104, Republic of Korea
| | - Mun Bae Lee
- Department of Mathematics, College of Basic Science, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea
| | - Hak Young Rhee
- Department of Neurology, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea; Department of Medicine, Kyung Hee University College of Medicine, 26 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Soonchan Park
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea; Department of Medicine, Kyung Hee University College of Medicine, 26 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Chang-Woo Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea; Department of Medicine, Kyung Hee University College of Medicine, 26 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Ah Rang Cho
- Department of Medicine, Kyung Hee University College of Medicine, 26 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea; Department of Psychiatry, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea
| | - Oh In Kwon
- Department of Mathematics, College of Basic Science, Konkuk University, 120 Neungdong-ro, Gwangjin-gu, Seoul 05029, Republic of Korea.
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdong-Gu, Seoul 05278, Republic of Korea; Department of Medicine, Kyung Hee University College of Medicine, 26 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea.
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26
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Bijlsma L, Xu L, Gracia-Marín E, Pitarch E, Serrano R, Kasprzyk-Hordern B. Understanding associations between antimicrobial agents usage and antimicrobial resistance genes prevalence at the community level using wastewater-based epidemiology: A Spanish pilot study. Sci Total Environ 2024; 926:171996. [PMID: 38547975 DOI: 10.1016/j.scitotenv.2024.171996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/25/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
Understanding the development and spread of antimicrobial resistance (AMR) is important for combating this global threat for public health. Wastewater-based epidemiology (WBE) is a complementary approach to current surveillance programs that minimizes some of the existing limitations. The aim of the present study is to explore WBE for monitoring antibiotics and antibiotic resistance genes (ARGs) in wastewater samples collected during 2021/2022 from the city of Castellon (Spain). Eighteen commonly prescribed antibiotics have been selected and measured by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS), with triple quadrupole mass analysers. Moreover, qPCR for specific ARGs has been performed to obtain information of these genes in co-presence with antibiotics. All selected ARGs, along with a total of 11 antibiotics, were identified. The highest population-normalized daily loads were observed for the macrolide azithromycin, followed by the quinolones ciprofloxacin and levofloxacin. Subsequently, daily consumption estimates based on wastewater data were compared with prescription data of antibiotics. Statistical analyses were conducted to explore if there is correlation between antibiotics and ARGs. While no correlations were found between antibiotics and their corresponding ARGs, certain correlations (p < 0.05) were identified among non-corresponding ARGs. In addition, a strong positive correlation was found between the sum of all antibiotics and the intl1 gene. Moreover, population-normalized ARG loads significantly correlate with the 16S rRNA-normalized ARG loads, serving as an indicator for population size. Results provide a baseline for future work and a proof-of-concept emphasising the need for future work and long-term surveillance, and highlight the need of similar programs at a regional and global levels worldwide.
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Affiliation(s)
- Lubertus Bijlsma
- Environmental and Public Health Analytical Chemistry, University Jaume I, E-12071 Castellón, Spain.
| | - Like Xu
- Department of Chemistry, University of Bath, Claverton Down BA27AY, United Kingdom
| | - Elisa Gracia-Marín
- Environmental and Public Health Analytical Chemistry, University Jaume I, E-12071 Castellón, Spain
| | - Elena Pitarch
- Environmental and Public Health Analytical Chemistry, University Jaume I, E-12071 Castellón, Spain
| | - Roque Serrano
- Environmental and Public Health Analytical Chemistry, University Jaume I, E-12071 Castellón, Spain
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27
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Gonzalez-Urbistondo F, Alperi A, Moris C, Avanzas P. μQFR in ASET Pilot Studies: More Assets in the decision-making process for stable ischemic heart disease. Int J Cardiol 2024; 403:131880. [PMID: 38373682 DOI: 10.1016/j.ijcard.2024.131880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 02/21/2024]
Affiliation(s)
| | - Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain.
| | - Cesar Moris
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain; Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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28
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Baskin PK, Barkhof F, Burch R, Callaghan BC, Ciccarelli O, Hedera P, Hershey LA, Jobst BC, Pieper KM, Quimby SL, Rahkola A, Schneider AL, Worrall BB, Wusthoff CJ, Merino JG. Open Peer Review Reports: A Pilot Project in Neurology®. Neurology 2024; 102:e209462. [PMID: 38608230 DOI: 10.1212/wnl.0000000000209462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Affiliation(s)
- Patricia K Baskin
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Frederik Barkhof
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Rebecca Burch
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Brian C Callaghan
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Olga Ciccarelli
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Peter Hedera
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Linda A Hershey
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Barbara C Jobst
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Kathleen M Pieper
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Sharon L Quimby
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Andrea Rahkola
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Andrea L Schneider
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Bradford B Worrall
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Courtney J Wusthoff
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - José G Merino
- From the American Academy of Neurology (P.K.B., K.M.P., S.L.Q., A.R.), Minneapolis, MN; Department of Radiology and Nuclear Medicine (F.B.), VU University Medical Centre, Amsterdam, the Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, United Kingdom; Larner College of Medicine (R.B.), University of Vermont, Burlington, VT; Department of Neurology (B.C.C.), Veterans Affairs Ann Arbor Health System, MI; Department of Neuroinflammation (O.C.), Institute of Neurology, University College London, United Kingdom; Department of Neurology (P.H.), University of Louisville, KY; University of Oklahoma Health Sciences Center (L.A.H.), Oklahoma City; Dartmouth-Hitchcock Epilepsy Center and Department of Neurology (B.C.J.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Neurology (A.L.S.), Division of Neurocritical Care Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia; Department of Neurology (B.B.W.), University of Virginia, Charlottesville; Neurology and Neurological Sciences (C.J.W.), Pediatrics Neonatal Medicine, Neurocritical Care Neurology, Lucile Packard Children's Hospital Neuro NICU, Division of Child Neurology, Stanford, CA; and Department of Neurology (J.G.M.), Georgetown University School of Medicine, MedStar Georgetown University Hospital, Washington, DC
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Karr JE, Iverson GL, Boudreau N, Zafonte R. Treatment of chronic symptoms following mild traumatic brain injury with transcranial LED: a sham run-in pilot study of photobiomodulation therapy. Brain Inj 2024; 38:425-435. [PMID: 38329020 DOI: 10.1080/02699052.2024.2309258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
PRIMARY OBJECTIVE We evaluated whether photobiomodulation with red/near infrared light applied transcranially via light emitting diodes (LED) was associated with reduced symptoms and improved cognitive functioning in patients with chronic symptoms following mild traumatic brain injury. RESEARCH DESIGN Participants (3 men, 6 women; 22-61 years-old) underwent a 6-week intervention involving 18 40-minute transcranial LED treatment sessions. METHODS AND PROCEDURES Reliable change indices were calculated for 10 neuropsychological test scores and 3 self-report questionnaires of subjective cognition, post-concussion symptoms, and depression at baseline and following treatment. Questionnaires were also administered after 2-week sham and at 1-month and 2-month follow-ups. MAIN OUTCOME AND RESULTS Only 2 participants improved on neuropsychological testing. On questionnaires, 4 reported improved cognition, 5 reported improved post-concussion symptoms, and 3 reported improved depression. Significant improvement in 2 or more domains was reported by 4 participants and mostly maintained at both follow-ups. CONCLUSIONS Most participants did not improve on neuropsychological testing. A minority self-reported improvement in symptoms, potentially explained by the intervention, psychiatric medication changes, placebo effects, or other factors. Selecting participants with different clinical characteristics, and dosing and delivery system changes, may produce different results. A study design accounting for placebo effects appears warranted in future trials.
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Affiliation(s)
- Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and the Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, Massachusetts, USA
- MassGeneral Hospital for Children Sports Concussion Program, Boston, Massachusetts, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, Massachusetts, USA
| | - Nancy Boudreau
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Schoen Adams Research Institute at Spaulding Rehabilitation, Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
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Lazeron-Savu E, Lenaert B, Dijkstra J, Ponds R, van Heugten C. Feasibility of a novel blended-care intervention for fatigue after acquired brain injury: a pilot study of the Tied by Tiredness intervention. Brain Inj 2024; 38:448-458. [PMID: 38324645 DOI: 10.1080/02699052.2024.2311346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Evidence-based treatments for fatigue after brain injury are scarce and often not personalized. An approach to foster personalization is Experience Sampling Methodology (ESM), consisting of repeated daily measurements of fatigue and related factors in daily life. We investigated the feasibility and usability of a novel six-week ESM-based intervention for fatigue after brain injury. MATERIALS AND METHODS Ten individuals with acquired brain injury (six men; four women) aged between 36-70 years (M = 53.3, SD = 12.9) used a mHealth application for three days each week during six-weeks; seven completed the intervention. Momentary fatigue, activities, mood, worrying, and social context were assessed with ESM and participants received weekly personalized feedback by a therapist.. RESULTS 56% of ESM-questionnaires (568/1008) were completed, providing detailed insights into individual fatigue patterns. No statistically significant decrease in response rate was found over the course of treatment. Qualitative feedback from participants revealed increased insight into factors underlying fatigue, and no problems with treatment duration or difficulties using the app. Five participants showed a decline in fatigue level during treatment. CONCLUSIONS This pilot study provides initial support for the feasibility and usability of this novel blended-care intervention, aimed at alleviating fatigue through personalized feedback and treatment strategies.
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Affiliation(s)
- Ela Lazeron-Savu
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bert Lenaert
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Lifespan Psychology, Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Jeanette Dijkstra
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rudolf Ponds
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maasticht University, Maastricht, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Caroline van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Limburg Brain Injury Center, Maasticht University, Maastricht, The Netherlands
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Udoh K, Wessel C, Branch R, Mahler J, Holland J, Coleman B, Alluri S, Jordan S, Ahmed A, Polzin B, Dye C, Smith K, Brown A, Gully Z, Sawning S, Ziegler C, Ruther M, Jones C, Miller K. Evaluating the Feasibility of a Novel Firearm Injury Prevention Program for Pre-adolescent Children Through Health Care and Community-Based Partnerships: The Future Healers Program Pilot Study. Am Surg 2024; 90:1050-1058. [PMID: 38093402 DOI: 10.1177/00031348231220595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
BACKGROUND Firearm violence is an American public health crisis that negatively impacts children and disproportionately affects Black youth. Few firearm injury prevention programs have been described in pre-adolescent children. The Future Healers Program is a novel collaboration constructed via partnership between the medical school, trauma center, academic surgery department, and local non-profit community organization. Our study sought to evaluate if (1) partnering with community organizations facilitated recruitment of children with prior exposure to firearm violence and (2) the health care community was a potential trusted partner appropriate for program delivery. METHODS Children aged 4-13 were recruited to join the program via news outlets and social media and in partnership with a local non-profit organization. Of the children and parents participating in the program, 48% (44/92) and 59% (38/64), respectively, completed an IRB-approved survey study. Pearson's chi-square, percentages, and 95% confidence intervals evaluated differences between children and caregivers on sociodemographic characteristics, firearm exposure (FE), firearm violence exposure (FVE), and perception of health care. Participant's residence was geocoded in relationship to incidents of firearm injury (2008-2021) in the same region. RESULTS Caregivers (95%) and children (84%) reported substantial exposure to firearm violence and resided in areas with frequent firearm injury incidents. Notably, 82% of caregivers and 66% of children reported having a family member injured by gunfire. A high percentage of caregivers (79%) and children (91%) self-reported trust in the health care system. CONCLUSION Partnerships between community organizations and health care systems can develop prevention programs that effectively recruit and engage pre-adolescent children impacted by firearm violence.
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Affiliation(s)
- Karen Udoh
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Caitlin Wessel
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Rheyana Branch
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Jessica Mahler
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Joseph Holland
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Briana Coleman
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Satya Alluri
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Symone Jordan
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Anam Ahmed
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Baylee Polzin
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Crystal Dye
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Kiara Smith
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Alyssa Brown
- Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Zahara Gully
- Jefferson Community and Technical College, Louisville, KY, USA
| | - Susan Sawning
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Craig Ziegler
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Matthew Ruther
- University of Louisville School of Urban and Public Affairs, Louisville, KY, USA
| | - Christopher Jones
- University of Louisville School of Medicine, Louisville, KY, USA
- Department of Surgery, Division of Transplant, University of Louisville School of Medicine, Louisville, KY, USA
| | - Keith Miller
- University of Louisville School of Medicine, Louisville, KY, USA
- Department of Surgery, Division of Trauma and Surgery Critical Care, University of Louisville School of Medicine, Louisville, KY, USA
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Maddaloni E, Naciu AM, Mignogna C, Galiero R, Amendolara R, Fogolari M, Satta C, Serafini C, Angeletti S, Cavallo MG, Cossu E, Sasso FC, Buzzetti R, Pozzilli P. Saxagliptin/dapagliflozin is non-inferior to insulin glargine in terms of β-cell function in subjects with latent autoimmune diabetes in adults: A 12-month, randomized, comparator-controlled pilot study. Diabetes Obes Metab 2024; 26:1670-1677. [PMID: 38297915 DOI: 10.1111/dom.15469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
AIM To compare the efficacy and safety of saxagliptin/dapagliflozin and insulin glargine in people with latent autoimmune diabetes in adults (LADA). METHODS In this phase 2b multicentre, open-label, comparator-controlled, parallel-group, non-inferiority study, we randomly assigned 33 people with LADA who had a fasting C-peptide concentration ≥0.2 nmol/L (0.6 ng/mL) to receive 1-year daily treatment with either the combination of saxagliptin (5 mg) plus dapagliflozin (10 mg) or insulin glargine (starting dose: 10 IU), both on top of metformin. The primary outcome was the 2-h mixed meal-stimulated C-peptide area under the curve (AUC), measured 12 months after randomization. Secondary outcomes were glycated haemoglobin (HbA1c) levels, change in body mass index (BMI), and hypoglycaemic events. RESULTS In the modified intention-to-treat analysis, the primary outcome was similar in participants assigned to saxagliptin/dapagliflozin or to insulin glargine (median C-peptide AUC: 152.0 ng*min/mL [95% confidence interval {CI} 68.2; 357.4] vs. 122.2 ng*min/mL [95% CI 84.3; 255.8]; p for noninferiority = 0.0087). Participants randomized to saxagliptin/dapagliflozin lost more weight than those randomized to insulin glargine (median BMI change at the end of the study: -0.4 kg/m2 [95% CI -1.6; -0.3] vs. +0.4 kg/m2 [95% CI -0.3; +1.1]; p = 0.0076). No differences in HbA1c or in the number of participants experiencing hypoglycaemic events were found. CONCLUSIONS Saxagliptin/dapagliflozin was non-inferior to glargine in terms of β-cell function in this 12-month, small, phase 2b study, enrolling people with LADA with still viable endogenous insulin production. Weight loss was greater with saxagliptin/dapagliflozin, with no differences in glycaemic control or hypoglycaemic risk.
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Affiliation(s)
- Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Anda M Naciu
- Unit of Metabolic Bone and Thyroid Diseases, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Carmen Mignogna
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Rocco Amendolara
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marta Fogolari
- Unit of Clinical Laboratory Science, Campus Bio-Medico University of Rome, Rome, Italy
- Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Chiara Satta
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Chiara Serafini
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Silvia Angeletti
- Unit of Clinical Laboratory Science, Campus Bio-Medico University of Rome, Rome, Italy
- Laboratory Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Efisio Cossu
- Diabetology Unit, Policlinico Universitario of Cagliari, Cagliari, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Raffaella Buzzetti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Pozzilli
- Diabetes, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Centre of Immunobiology, Blizard Institute, St. Bartholomew's and London School of Medicine, London, UK
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Sethi S, Wakeham D, Ketter T, Hooshmand F, Bjornstad J, Richards B, Westman E, Krauss RM, Saslow L. Ketogenic Diet Intervention on Metabolic and Psychiatric Health in Bipolar and Schizophrenia: A Pilot Trial. Psychiatry Res 2024; 335:115866. [PMID: 38547601 DOI: 10.1016/j.psychres.2024.115866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/14/2024]
Abstract
The ketogenic diet (KD, also known as metabolic therapy) has been successful in the treatment of obesity, type 2 diabetes, and epilepsy. More recently, this treatment has shown promise in the treatment of psychiatric illness. We conducted a 4-month pilot study to investigate the effects of a KD on individuals with schizophrenia or bipolar disorder with existing metabolic abnormalities. Twenty-three participants were enrolled in a single-arm trial. Results showcased improvements in metabolic health, with no participants meeting metabolic syndrome criteria by study conclusion. Adherent individuals experienced significant reduction in weight (12 %), BMI (12 %), waist circumference (13 %), and visceral adipose tissue (36 %). Observed biomarker enhancements in this population include a 27 % decrease in HOMA-IR, and a 25 % drop in triglyceride levels. In psychiatric measurements, participants with schizophrenia showed a 32 % reduction in Brief Psychiatric Rating Scale scores. Overall Clinical Global Impression (CGI) severity improved by an average of 31 %, and the proportion of participants that started with elevated symptomatology improved at least 1-point on CGI (79 %). Psychiatric outcomes across the cohort encompassed increased life satisfaction (17 %) and enhanced sleep quality (19 %). This pilot trial underscores the potential advantages of adjunctive ketogenic dietary treatment in individuals grappling with serious mental illness.
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Affiliation(s)
- Shebani Sethi
- Metabolic Psychiatry, Dept. of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, CA, USA.
| | - Diane Wakeham
- Metabolic Psychiatry, Dept. of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, CA, USA
| | - Terence Ketter
- Metabolic Psychiatry, Dept. of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, CA, USA
| | - Farnaz Hooshmand
- Metabolic Psychiatry, Dept. of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, CA, USA
| | - Julia Bjornstad
- Metabolic Psychiatry, Dept. of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, CA, USA
| | - Blair Richards
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Eric Westman
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Ronald M Krauss
- Department of Pediatrics and Medicine, University of California-San Francisco, San Francisco, CA, USA
| | - Laura Saslow
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Thirumalai A, Chao JH, Kaleru T, Dong X, Mandava P, Khakpour D, Hirsch IB. Bridging dose of U-100 glargine with first dose of insulin degludec improves glycaemia in the 48 h after transition in twice-daily glargine users. Diabetes Obes Metab 2024; 26:1868-1876. [PMID: 38418413 DOI: 10.1111/dom.15502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/01/2024]
Abstract
AIMS To study the effects of a bridging dose of U-100 glargine (U-100G) with the first dose of degludec in type 1 diabetes (T1D) patients transitioning from glargine to degludec, by comparing the glucose metrics 48 h before and after the transition. MATERIALS AND METHODS Patients with T1D on a stable U-100G regimen and with glycated haemoglobin concentration <75 mmol/mol were randomized (double-blind) to one dose of placebo or U-100G with first dose of degludec, administered at 9:00 pm. Patients on once-daily U-100G at baseline received 50% of total U-100G dose (bridging dose), while patients on twice-daily U-100G received 50% of the evening U-100G dose. Participants wore a continuous glucose monitor during the study. RESULTS Forty participants were randomized, of whom 37 completed the study. The cohort was 65% male, the mean age was 47 years, duration of T1D 22 years, BMI 26 kg/m2, HbA1c 51 mmol/mol and total daily insulin dose 0.7 units/kg body weight. The bridging group included 19 participants (once-daily U-100G: n = 12; twice-daily U-100G: n = 7) and the placebo group included 18 participants (once-daily U-100G: n = 12; twice-daily U-100G: n = 6). Change in time in range (TIR) was not significantly different between the two treatment groups. In secondary analyses, among twice-daily U-100G users, TIR (3.9-10 mmol/L) increased 8% in the bridging group in the 48 h after first dose of degludec compared to the preceding 48 h, while participants in the placebo group had a 9.5% decrease (p = 0.027). CONCLUSIONS A subgroup of well-controlled twice-daily U-100G users transitioning to degludec benefited from a 50% bridging dose of evening U-100G with the first dose of degludec in a small pilot study.
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Affiliation(s)
- Arthi Thirumalai
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington, USA
| | - Jing H Chao
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington, USA
| | - Thanmai Kaleru
- Internal Medicine Residency, Trios Health, Kennewick, Washington, USA
| | - Xiaofu Dong
- University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
| | - Patali Mandava
- University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
| | - Dori Khakpour
- University of Washington Medicine Diabetes Institute, Seattle, Washington, USA
| | - Irl B Hirsch
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington, USA
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Sauvain JJ, Hemmendinger M, Charreau T, Jouannique V, Debatisse A, Suárez G, Hopf NB, Guseva Canu I. Metal and oxidative potential exposure through particle inhalation and oxidative stress biomarkers: a 2-week pilot prospective study among Parisian subway workers. Int Arch Occup Environ Health 2024; 97:387-400. [PMID: 38504030 PMCID: PMC10999389 DOI: 10.1007/s00420-024-02054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/05/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE In this pilot study on subway workers, we explored the relationships between particle exposure and oxidative stress biomarkers in exhaled breath condensate (EBC) and urine to identify the most relevant biomarkers for a large-scale study in this field. METHODS We constructed a comprehensive occupational exposure assessment among subway workers in three distinct jobs over 10 working days, measuring daily concentrations of particulate matter (PM), their metal content and oxidative potential (OP). Individual pre- and post-shift EBC and urine samples were collected daily. Three oxidative stress biomarkers were measured in these matrices: malondialdehyde (MDA), 8-hydroxy-2'deoxyguanosine (8-OHdG) and 8-isoprostane. The association between each effect biomarker and exposure variables was estimated by multivariable multilevel mixed-effect models with and without lag times. RESULTS The OP was positively associated with Fe and Mn, but not associated with any effect biomarkers. Concentration changes of effect biomarkers in EBC and urine were associated with transition metals in PM (Cu and Zn) and furthermore with specific metals in EBC (Ba, Co, Cr and Mn) and in urine (Ba, Cu, Co, Mo, Ni, Ti and Zn). The direction of these associations was both metal- and time-dependent. Associations between Cu or Zn and MDAEBC generally reached statistical significance after a delayed time of 12 or 24 h after exposure. Changes in metal concentrations in EBC and urine were associated with MDA and 8-OHdG concentrations the same day. CONCLUSION Associations between MDA in both EBC and urine gave opposite response for subway particles containing Zn versus Cu. This diverting Zn and Cu pattern was also observed for 8-OHdG and urinary concentrations of these two metals. Overall, MDA and 8-OHdG responses were sensitive for same-day metal exposures in both matrices. We recommend MDA and 8-OHdG in large field studies to account for oxidative stress originating from metals in inhaled particulate matter.
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Affiliation(s)
- Jean-Jacques Sauvain
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University Lausanne, Route de la Corniche 2, 1066, Epalinges, Switzerland.
| | - Maud Hemmendinger
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University Lausanne, Route de la Corniche 2, 1066, Epalinges, Switzerland
| | - Thomas Charreau
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University Lausanne, Route de la Corniche 2, 1066, Epalinges, Switzerland
| | - Valérie Jouannique
- Service Santé-Travail, Régie autonome des transports parisiens (RATP), 88 Boulevard Sébastopol, 75003, Paris, France
| | - Amélie Debatisse
- Service Santé-Travail, Régie autonome des transports parisiens (RATP), 88 Boulevard Sébastopol, 75003, Paris, France
| | - Guillaume Suárez
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University Lausanne, Route de la Corniche 2, 1066, Epalinges, Switzerland
| | - Nancy B Hopf
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University Lausanne, Route de la Corniche 2, 1066, Epalinges, Switzerland
| | - Irina Guseva Canu
- Department of Occupational and Environmental Health, Center for Primary Care and Public Health (Unisanté), University Lausanne, Route de la Corniche 2, 1066, Epalinges, Switzerland
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Rahman A, Othman N, Kuddus MA, Hasan MZ. Impact of the COVID-19 pandemic on child malnutrition in Selangor, Malaysia: A pilot study. J Infect Public Health 2024; 17:833-842. [PMID: 38547630 DOI: 10.1016/j.jiph.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Child malnutrition risk factors are globally recognized, but the specific impact of the COVID-19 pandemic on the prevalence of child malnutrition, considering socioeconomic burdens and changes in family lifestyles, remains underexplored. This study aims to identify the significance of COVID-19-related factors in relation to the prevalence of child malnutrition in Selangor, Malaysia. METHODS Purposive sampling was employed in this pilot study to select the households with under-5 children and, a structured questionnaire was developed to gather data. Chi-squared tests, logistic regression modelling and World Health Organisation AnthroPlus software-based visualization were used for analyses. RESULTS The present study's findings indicate that demographic and social factors, including 'Citizenship,' 'Type of House,' 'Number of Earning Members,' 'Father's Highest Educational Level,' and 'Number of Children in a Family,' have a statistically significant association with Wasting. Additionally, the mother's 'Highest Educational Level' is found to be linked to underweight prevalence. Within COVID-19 factors, "COVID-19 Impact on Employment/Business" demonstrated significance for both stunting and wasting. Multivariate analysis revealed disparities in childhood malnutrition by gender, age, and factors such as "COVID-19 impact on children's physical activity" and "COVID-19 impact on children's decrease in health over the last two weeks." CONCLUSIONS This study identified COVID-19 factors alongside sociodemographic variables with statistically significant relationships impacting childhood malnutrition in Selangor, Malaysia. The results underscored the substantial influence of the COVID-19 pandemic on child malnutrition prevalence. Decision-makers at family and community levels can benefit by considering these factors in their actions. However, the study's limitation lay in its dataset, urging larger-scale analyses to explore further sub-categories of the examined variables.
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Affiliation(s)
- Azizur Rahman
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, Australia.
| | - Nezza Othman
- School of Science, Monash University Malaysia, Bandar Sunway, Selangor D.E., Malaysia
| | - Md Abdul Kuddus
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, Australia; Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia; Department of Mathematics, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Md Zobaer Hasan
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, Australia; School of Science, Monash University Malaysia, Bandar Sunway, Selangor D.E., Malaysia
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Barcala-Furelos R, de Oliveira J, Duro-Pichel P, Colón-Leira S, Sanmartín-Montes M, Aranda-García S. In-water resuscitation during a surf rescue: Time lost or breaths gained? A pilot study. Am J Emerg Med 2024; 79:48-51. [PMID: 38341994 DOI: 10.1016/j.ajem.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/02/2024] [Accepted: 02/03/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND A technique called in-water resuscitation (IWR) was devised on a surfboard to ventilate persons who seemingly did not breathe upon a water rescue. Despite IWR still raises uncertainties regarding its applicability, this technique is recommended by the International Liaison Committee for Resuscitation (ILCOR). Thus, this study aimed to evaluate the feasibility of IWR with a rescue board before and during towing and, to compare rescue times and rescue-associated fatigue levels between rescues with rescue breath attempts and without (SR). METHODS A randomized crossover pilot test was conducted: 1) IWR test with pocket mask and, 2) Conventional SR test. IWR tests were conducted using a Laerdal ResusciAnne manikin (Stavanger, Norway). Three groups of variables were recorded: a) rescue time (in s), b) effective ventilations during rescue, and c) rating of perceived effort (RPE). RESULTS Focusing on the rescue time, the performance SR was significantly faster than IWR rescue which took 61 s longer to complete the rescue (Z = -2.805; p = 0.005). No significant differences were found between techniques for the RPE (T = -1.890; p = 0.095). In the IWR analysis, lifeguards performed an average of 27 ± 12 rescue breaths. CONCLUSION The application of IWR on a rescue board is feasible both at the time of rescue and during towing. It shortens the reoxygenation time but delays the arrival time to shore. Both IWR and SR result in similar levels of perceived fatigue.
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Affiliation(s)
- Roberto Barcala-Furelos
- Universidade de Vigo, REMOSS Research Group, Facultade de Ciencias da Educación e do Deporte, Pontevedra, Spain.
| | - Joel de Oliveira
- Universidade de Vigo, REMOSS Research Group, Facultade de Ciencias da Educación e do Deporte, Pontevedra, Spain; Surfing Medicine International, the Netherlands
| | - Paula Duro-Pichel
- Universidade de Vigo, REMOSS Research Group, Facultade de Ciencias da Educación e do Deporte, Pontevedra, Spain
| | - Sergio Colón-Leira
- Universidade de Vigo, REMOSS Research Group, Facultade de Ciencias da Educación e do Deporte, Pontevedra, Spain
| | - Marcos Sanmartín-Montes
- Universidade de Vigo, REMOSS Research Group, Facultade de Ciencias da Educación e do Deporte, Pontevedra, Spain
| | - Silvia Aranda-García
- GRAFAIS Research Group, Institut Nacional d'Educació Física de Catalunya (INEFC), Universitat de Barcelona, Barcelona, Spain
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Gavryutina I, Bochner R, Chin V, Bargman R. A Cross-Sectional Pilot Study of Parental Outdoor Play Preferences and Association With Child Overweight and Obesity. Clin Pediatr (Phila) 2024; 63:466-473. [PMID: 37246752 DOI: 10.1177/00099228231176350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Childhood obesity is highly prevalent among certain populations of New York. This cross-sectional pilot study examined the associations between parental attitudes about outdoor activities and body mass index (BMI). A questionnaire was distributed among parents of 1 to 13 aged children at ambulatory pediatric clinics. Of 104 children included in the study 57 were of normal weight and 47 were overweight or obese. Most parents of children with BMI <85% reported frequent playground utilization, considered longer hours to spend outside on weekdays, reported a larger total temperature range for outdoor playground utilization and a lower tolerable minimum temperature compared to parents of children with BMI ≥85%, p < .05. Only having a parent born outside of the United States remained a significant predictor of overweight and obesity in the final model. Parents of children with BMI < 85% are more willing to spend time outdoors, regardless of weather. Immigrant parents are protective against overweight.
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Affiliation(s)
- Irina Gavryutina
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Risa Bochner
- Department of Pediatrics, New York City Health and Hospitals Harlem Hospital, New York, NY, USA
| | - Vivian Chin
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Renee Bargman
- Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
- Department of Pediatrics, New York City Health and Hospitals Kings County Hospital, Brooklyn, NY, USA
- Department of Pediatrics, New York City Health and Hospital South Brooklyn Health, Brooklyn, NY, USA
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Lamontagne SJ, Gilbert JR, Zabala PK, Waldman LR, Zarate CA, Ballard ED. Clinical, behavioral, and electrophysiological profiles along a continuum of suicide risk: evidence from an implicit association task. Psychol Med 2024; 54:1431-1440. [PMID: 37997749 DOI: 10.1017/s0033291723003331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND An urgent need exists to identify neural correlates associated with differing levels of suicide risk and develop novel, rapid-acting therapeutics to modulate activity within these neural networks. METHODS Electrophysiological correlates of suicide were evaluated using magnetoencephalography (MEG) in 75 adults with differing levels of suicide risk. During MEG scanning, participants completed a modified Life-Death Implicit Association Task. MEG data were source-localized in the gamma (30-58 Hz) frequency, a proxy measure of excitation-inhibition balance. Dynamic causal modeling was used to evaluate differences in connectivity estimates between risk groups. A proof-of-concept, open-label, pilot study of five high risk participants examined changes in gamma power after administration of ketamine (0.5 mg/kg), an NMDAR antagonist with rapid anti-suicide ideation effects. RESULTS Implicit self-associations with death were stronger in the highest suicide risk group relative to all other groups, which did not differ from each other. Higher gamma power for self-death compared to self-life associations was found in the orbitofrontal cortex for the highest risk group and the insula and posterior cingulate cortex for the lowest risk group. Connectivity estimates between these regions differentiated the highest risk group from the full sample. Implicit associations with death were not affected by ketamine, but enhanced gamma power was found for self-death associations in the left insula post-ketamine compared to baseline. CONCLUSIONS Differential implicit cognitive processing of life and death appears to be linked to suicide risk, highlighting the need for objective measures of suicidal states. Pharmacotherapies that modulate gamma activity, particularly in the insula, may help mitigate risk.Clinicaltrials.gov identifier: NCT02543983, NCT00397111.
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Affiliation(s)
- Steven J Lamontagne
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Jessica R Gilbert
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Paloma K Zabala
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Laura R Waldman
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Carlos A Zarate
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Colosimo S, Martínez-Sánchez MA, Balaguer-Román A, Fernández-Ruiz VE, Núñez-Sánchez MA, Ferrer-Gómez M, Frutos MD, Tomlinson JW, Bertoli S, Marchesini G, Ramos-Molina B. A novel model for predicting diabetes remission after bariatric surgery based on the measurement of C-peptide and creatinine in serum: A pilot study. Nutr Metab Cardiovasc Dis 2024; 34:1142-1145. [PMID: 38220504 DOI: 10.1016/j.numecd.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/24/2023] [Accepted: 12/10/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND AND AIMS Bariatric surgery is effective for treating type 2 diabetes (T2D) in patients with obesity, although a significant proportion of these patients do not achieve diabetes remission after the surgery even after significant weight loss and metabolic improvement. C-peptide is a valuable marker of beta cell function and insulin secretion, but renal function must be considered when interpreting measurements in patients with T2D. The study aims to investigate the association of serum levels of C-peptide adjusted for creatinine with diabetes remission and glycemic target achievement after bariatric surgery in patients with obesity and T2D. METHODS AND RESULTS Prospective data from a cohort of 84 patients with obesity and T2D submitted to Roux-en-Y gastric bypass (RYGB) were collected at baseline and at least a 6-month follow up. A multivariate binomial regression model showed that Ln(C-peptide/creatinine) and age were significantly associated with 6-month T2D remission. The area under the curve for the receiver operating characteristic analysis (AUROC) to predict remission was 0.87, and more accurate than the AUROC based on C-peptide levels alone (0.75). The same model was also able to predict achieving an HbA1c target of 7 % (53 mmol/mol) (AUROC 0.96). CONCLUSION In conclusion, Ln(C-peptide/creatinine) ratio could be a useful tool in predicting T2D remission and target achievement after RYGB surgery, providing a more accurate reflection of beta cell function in bariatric patients.
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Affiliation(s)
- Santo Colosimo
- Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; School of Nutrition Science, University of Milan, Milan, Italy; Obesity Research Lab, Istituto Auxologico Italiano, Milan, Italy.
| | - María A Martínez-Sánchez
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Andrés Balaguer-Román
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain; Department of General and Digestive System Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Virginia E Fernández-Ruiz
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain; Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - María A Núñez-Sánchez
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Mercedes Ferrer-Gómez
- Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - María Dolores Frutos
- Department of General and Digestive System Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Simona Bertoli
- Obesity Research Lab, Istituto Auxologico Italiano, Milan, Italy; Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Bruno Ramos-Molina
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
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Lorenz M, Baum F, Kloss P, Langer N, Arsene V, Warner L, Panelli A, Hartmann FV, Fuest K, Grunow JJ, Enghard P, Schaller SJ. Robotic-Assisted In-Bed Mobilization in Ventilated ICU Patients With COVID-19: An Interventional, Randomized, Controlled Pilot Study (ROBEM II Study). Crit Care Med 2024; 52:683-693. [PMID: 38236076 DOI: 10.1097/ccm.0000000000006194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
OBJECTIVES The COVID-19 pandemic significantly impacted global healthcare systems, particularly in managing critically ill mechanically ventilated patients. This study aims to assess the feasibility of robotic-assisted mobilization in COVID-19 patients. DESIGN Randomized controlled pilot study. SETTING Four COVID-19 specialized ICUs at Charité-Universitätsmedizin Berlin (March 2021 to February 2022). PATIENTS Twenty critically ill COVID-19 patients expected to require greater than 24 hours of ventilation. INTERVENTIONS A 5-day intervention phase with bid robotic-assisted mobilization greater than or equal to 20 minutes and follow-up at day 180, compared with standard care. MEASUREMENTS AND MAIN RESULTS Intervention sessions were conducted in 98.9% according to protocol, with one session missing due to staff shortage. Primary outcome was the mobilization level measured with the ICU Mobility Scale (IMS) and Surgical ICU Optimal Mobilization Score (SOMS), assessed until day 5 or extubation. Safety events were recorded during mobilization. The median IMS and SOMS were 0 (0-0.16) and 1 (1-1.03) in the intervention group, and 0 (0-0.15) ( p = 0.77) and 0.8 (0.65-1.20) ( p = 0.08) in the standard care group, respectively. Significant secondary outcomes included average number of mobilization sessions (intervention: 8.5 [7.75-10] vs. standard care: 4.5 [3.5-5]; p = 0.001), total mobilization time (intervention: 232.5 min [187.25-266.5 min] vs. standard care: 147.5 min [107.5-167.5 min]; p = 0.011), and healthcare providers per session (intervention: 2 [2-2] vs. standard care: 1 [1-1.4]; p = 0.001) during intervention. Four safety events (hypertension and agitation, n = 2 each) in the intervention group and none in the standard care group were reported. CONCLUSIONS Robotic-assisted mobilization in mechanically ventilated COVID-19 patients appears to be safe and feasible.
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Affiliation(s)
- Marco Lorenz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
- Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany
| | - Felix Baum
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Philipp Kloss
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Nadine Langer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Vanessa Arsene
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Linus Warner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Alessandro Panelli
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Frederike V Hartmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Kristina Fuest
- Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany
| | - Julius J Grunow
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Philipp Enghard
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Nephrology and Medical Intensive Care, Berlin, Germany
| | - Stefan J Schaller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
- Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany
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Pettit NR, Horner D, Freeman S, Rieger K. Pilot intervention to increase uptake of lung cancer screening through the emergency department. Am J Emerg Med 2024; 79:157-160. [PMID: 38432156 DOI: 10.1016/j.ajem.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION The goal of this study is to demonstrate the feasibility of referring patients for lung cancer screening (LCS) from the emergency department (ED) as a method to increase the uptake of LCS. METHODS This is a single-arm pilot study at a large safety-net ED. ED LCS-eligible patients were offered a referral to our LCS clinic upon ED discharge. The primary outcome was the frequency at which patients connected with the LCS clinic. RESULTS During the study period, 105 patients were approached; 26 (24.8%) participated. Reasons for non-enrollment include 29 (27.6%) who were not interested in research, 10 (9.5%) who did not speak English, and 40 (38.1%) who did not meet the pack-years criteria. Seventeen patients (65.4%, 17/26) connected with the LCS clinic, with 10 (38.5%) having been seen in the clinic and received a low dose computed tomography (LDCT) scan. Of the 17 that were connected with the clinic, 7 (26.9%) had a non-LDCT chest CT scan in the past year. Of those that were not seen in the clinic (n = 9), 4 (44.4%) were unreachable via 3 phone calls and a post-marked letter, and 3 (33.3%) did not attend the scheduled appointment, and 2 (22.2%) were delayed due to COVID-19. Of those that had CT scans over the study period (n = 17), 0 scans were normal, one patient (5.9%) had asymptomatic lung cancer, 7 (41.2%) had pulmonary nodules, 11 (64.7%) had emphysema, and 9 (52.9%) had coronary artery disease. CONCLUSION This pilot study suggests the feasibility and suggests initial indications of the efficacy of referring ED patients for LCS.
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Affiliation(s)
- Nicholas R Pettit
- Department of Emergency Medicine, Indiana University, Indianapolis, IN, United States of America.
| | - Diane Horner
- Eskenazi Health, Lung Cancer Screening Program, Indianapolis, IN, United States of America
| | - Sara Freeman
- Eskenazi Health, Lung Cancer Screening Program, Indianapolis, IN, United States of America
| | - Karen Rieger
- Eskenazi Health, Lung Cancer Screening Program, Indianapolis, IN, United States of America; Department of Thoracic Surgery, Indiana University, Indianapolis, IN, United States of America
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Weber C, Müller A, Freigang M, von der Hagen M, Günther R. 'Reading the palm' - A pilot study of grip and finger flexion strength as an outcome measure in 5q spinal muscular atrophy. Brain Dev 2024; 46:189-198. [PMID: 38331667 DOI: 10.1016/j.braindev.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Innovative RNA modifying and gene replacement therapies are currently revolutionizing the therapeutic landscape in 5q-associated spinal muscular atrophy (SMA). In order to provide individual recommendations for choice of treatment and therapy (dis-) continuation, objective outcome measures are needed. The purpose of this study was to determine whether maximum isometric voluntary grip and finger flexion strength is a useful sensitive outcome measure in children and adult patients with SMA. METHODS In this non-interventional, longitudinal pilot study, we assessed grip and finger flexion strength on 39 patients with SMA II and III (n = 16 children, mean age = 10.0; n = 23 adults, mean age = 38.4) using the Weber hand and finger dynamometer HFD 200. Grip and finger flexion strength, clinical examinations and motor function scores (Revised Upper Limb Module, Hammersmith Functional Motor Scale Expanded) were assessed over a 12-month treatment period concurrent with the nusinersen treatment. RESULTS Grip and finger flexion strength was highly associated with motor function and disease severity, SMA type and SMN2 copy number. During nusinersen treatment, grip and finger flexion strength significantly increased in children and adults with SMA. CONCLUSION Grip and finger flexion strength measured with the HFD 200 is a promising sensitive outcome measure for SMA.
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Affiliation(s)
- Constanze Weber
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
| | - Anne Müller
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; Department of Neuropediatrics, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
| | - Maren Freigang
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
| | - Maja von der Hagen
- Department of Neuropediatrics, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany.
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus Dresden, Technische Universität Dresden, Dresden, Germany; German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany.
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Curtin C, Bandini LG, Forquer M, Cullen P, Rancaño KM, Must A, Schreck K, Bowling AB, Askenazy N, Wei X, Irish C, Stanish HI. A remotely-delivered pilot and feasibility program to promote physical and food literacy in adolescents with intellectual disabilities. J Appl Res Intellect Disabil 2024; 37:e13228. [PMID: 38520166 DOI: 10.1111/jar.13228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/01/2024] [Accepted: 03/04/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Youth with intellectual disabilities experience disparities in physical activity and diet quality. Physical and food literacy are hypothesised to support adoption of healthy lifestyles; however, few such interventions have been developed for this population. METHOD Participants with intellectual disabilities ages 12-16 years were recruited for a 12-week online sports skills and nutrition education intervention. Feasibility, acceptability, and preliminary efficacy were assessed by attendance, satisfaction, and pre-post measures of motor skills, perceived competence and motivation for physical activity, classifying foods, making healthy choices, and food consumption. RESULTS Six teens participated in the program and attended 87.5% of the sessions. Satisfaction data suggested that the program was well-received by both teens and parents. Trends toward improvements on physical activity and nutrition outcome measures were observed. CONCLUSIONS Preliminary data from this pilot study suggest that physical and food literacy in youth with intellectual disabilities can be improved, which in turn may contribute to the adoption of healthy lifestyles.
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Affiliation(s)
- C Curtin
- E.K. Shriver Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - L G Bandini
- E.K. Shriver Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - M Forquer
- George Washington University, Washington, DC, USA
| | - P Cullen
- E.K. Shriver Center, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - K M Rancaño
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - A Must
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - K Schreck
- Boston University, Boston, Massachusetts, USA
| | - A B Bowling
- Merrimack College, North Andover, Massachusetts, USA
| | - N Askenazy
- Boston University, Boston, Massachusetts, USA
| | - X Wei
- Boston University, Boston, Massachusetts, USA
| | - C Irish
- Brighton, Massachusetts, USA
| | - H I Stanish
- University of Massachusetts Boston, Boston, Massachusetts, USA
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Donckers J, van Drongelen J, Spaanderman MEA, Scholten RR. Unexplained recurrent pregnancy loss and markers of arterial vascular health: An experimental case-control study. BJOG 2024; 131:777-785. [PMID: 37849428 DOI: 10.1111/1471-0528.17688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE To investigate whether women with unexplained recurrent pregnancy loss have impaired arterial vascular health compared with controls, and to evaluate whether this is modifiable by exercise. DESIGN Experimental case-control pilot study. SETTING University medical centre in the Netherlands. POPULATION Twelve women with unexplained recurrent pregnancy loss, 11 nulliparous women and 19 primiparous women with a history of uncomplicated pregnancies. METHODS In all three groups we measured baseline characteristics, metabolic components and arterial vascular health, and repeated this in women with unexplained recurrent pregnancy loss after 1 month of protocolled and supervised cycle training. MAIN OUTCOME MEASURES Differences in arterial vascular health between women with unexplained recurrent pregnancy loss and controls, and the effect of exercise on arterial vascular health in women with unexplained recurrent pregnancy loss. RESULTS Women with unexplained recurrent pregnancy loss have a significantly increased carotid intima media thickness in comparison with both controls (both P < 0.01), a significantly decreased brachial endothelial dependent flow-mediated vasodilation in comparison with both controls (nulliparous: P < 0.01; primiparous: P = 0.05) and a significantly decreased femoral endothelial dependent flow-mediated vasodilation in comparison with primiparous women (P = 0.01). The endothelium independent glyceryl trinitrate response was similar in all groups. With 1 month of exercise, the carotid intima media thickness decreased significantly by 7% (P = 0.05) and the femoral FMD increased significantly by 10% (P = 0.01) in women with unexplained recurrent pregnancy loss. CONCLUSIONS Women with unexplained recurrent pregnancy loss have an impaired vascular health in comparison with controls. This impaired arterial vascular health can be improved by exercise.
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Affiliation(s)
- Janneke Donckers
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joris van Drongelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Research School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ralph R Scholten
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Presta P, Carullo N, Armeni A, Zicarelli MT, Musolino M, Bianco MG, Chiarella S, Andreucci M, Fiorillo AS, Pullano SA, Bolignano D, Coppolino G. Evaluation of arteriovenous fistula for hemodialysis with a new generation digital stethoscope: a pilot study. Int Urol Nephrol 2024; 56:1763-1771. [PMID: 38093038 DOI: 10.1007/s11255-023-03895-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/16/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND AIMS The management of complications of arteriovenous fistula (AVF) for hemodialysis, principally stenosis, remains a major challenge for clinicians with a substantial impact on health resources. Stenosis not infrequently preludes to thrombotic events with the loss of AVF functionality. A functioning AVF, when listened by a stethoscope, has a continuous systolic-diastolic low-frequency murmur, while with stenosis, the frequency of the murmur increases and the duration of diastolic component decreases, disappearing in severe stenosis. These evidences are strictly subjective and dependent from operator skill and experience. New generation digital stethoscopes are able to record sound and subsequently dedicated software allows to extract quantitative variables that characterize the sound in an absolutely objective and repeatable way. The aim of our study was to analyze with an appropriate software sounds from AVFs taken by a commercial digital stethoscope and to investigate the potentiality to develop an objective way to detect stenosis. METHODS Between September 2022 and January 2023, 64 chronic hemodialysis (HD) patients were screened by two blinded experienced examiners for recognized criteria for stenosis by Doppler ultrasound (DUS) and, consequently, the sound coming from the AVFs using a 3 M™ Littmann® CORE Digital Stethoscope 8570 in standardized sites was recorded. The sound waves were transformed into quantitative variables (amplitude and frequency) using a sound analysis software. The practical usefulness of the core digital stethoscope for a quick identification of an AVF stenosis was further evaluated through a pragmatic trial. Eight young nephrologist trainees underwent a simple auscultatory training consisting of two sessions of sound auscultation focusing two times on a "normal" AVF sound by placing the digital stethoscope on a convenience site of a functional AVF. RESULTS In 48 patients eligible, all sound components displayed, alone, a remarkable diagnostic capacity. More in detail, the AUC of the average power was 0.872 [95% CI 0.729-0.951], while that of the mean normalized frequency was 0.822 [95% 0.656-0.930]. From a total of 32 auscultations (eight different block sequences, each one comprising four auscultations), the young clinicians were able to identify the correct sound (stenosis/normal AVF) in 25 cases, corresponding to an overall accuracy of 78.12% (95% CI 60.03-90.72%). CONCLUSIONS The analysis of sound waves by a digital stethoscope permitted us to distinguish between stenotic and no stenotic AVFs. The standardization of this technique and the introducing of data in a deep learning algorithm could allow an objective and fast method for a frequent monitoring of AVF.
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Affiliation(s)
- Pierangela Presta
- Department of Health Sciences, Renal Unit, "Magna Græcia" University of Catanzaro, Viale Europa-Germaneto, 88100, Catanzaro, Italy
| | - Nazareno Carullo
- Department of Health Sciences, Renal Unit, "Magna Græcia" University of Catanzaro, Viale Europa-Germaneto, 88100, Catanzaro, Italy
| | - Annarita Armeni
- Renal Unit, "Pugliese-Ciaccio" Hospital of Catanzaro, 88100, Catanzaro, Italy
| | - Maria Teresa Zicarelli
- Department of Health Sciences, Renal Unit, "Magna Græcia" University of Catanzaro, Viale Europa-Germaneto, 88100, Catanzaro, Italy
| | - Michela Musolino
- Department of Health Sciences, Renal Unit, "Magna Græcia" University of Catanzaro, Viale Europa-Germaneto, 88100, Catanzaro, Italy
| | - Maria Giovanna Bianco
- BATS Laboratory, Department of Health Sciences, "Magna Græcia" University of Catanzaro, 88100, Catanzaro, Italy
| | - Salvatore Chiarella
- Renal Unit, "Pugliese-Ciaccio" Hospital of Catanzaro, 88100, Catanzaro, Italy
| | - Michele Andreucci
- Department of Health Sciences, Renal Unit, "Magna Græcia" University of Catanzaro, Viale Europa-Germaneto, 88100, Catanzaro, Italy
| | - Antonino S Fiorillo
- BATS Laboratory, Department of Health Sciences, "Magna Græcia" University of Catanzaro, 88100, Catanzaro, Italy
| | - Salvatore Andrea Pullano
- BATS Laboratory, Department of Health Sciences, "Magna Græcia" University of Catanzaro, 88100, Catanzaro, Italy
| | - Davide Bolignano
- Department of Health Sciences, Renal Unit, "Magna Græcia" University of Catanzaro, Viale Europa-Germaneto, 88100, Catanzaro, Italy
| | - Giuseppe Coppolino
- Department of Health Sciences, Renal Unit, "Magna Græcia" University of Catanzaro, Viale Europa-Germaneto, 88100, Catanzaro, Italy.
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Chen T, Chan HHL, de Almeida J, Goldstein DP, Gilbert RW, Yao CMKL, Irish JC, Davies JC. A 3D Analysis of Plating Strategies in Mandibular Reconstruction: A Randomized Control Pilot Study. Laryngoscope 2024; 134:2182-2186. [PMID: 37962081 DOI: 10.1002/lary.31171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/03/2023] [Accepted: 09/22/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE(S) The purpose of this study was to compare computer-assisted mandibular plating to conventional plating using quantitative metrics. METHODS Patients scheduled to undergo mandibular reconstruction were randomized to three-dimensional modelling for preoperative plate bending or intraoperative freehand bending. Preoperative and postoperative head and neck computed tomography scans were obtained to generate computer models of the reconstruction. The overall plate surface contact area, mean plate-to-bone distance, degree of conformance, and position of the condylar head within the glenoid fossa between pre- and post-operative scans were calculated. RESULTS Twenty patients were included with a mean age of 57.8 years (standard deviation [SD] = 13.6). The mean follow-up time was 9.8 months (range = 1.6-22.3). Reconstruction was performed with fibular (25%) or scapular free flaps (75%). The percentage of surface contact between the reconstructive plate and mandible was improved with three-dimensional models compared to freehand bending (93.9 ± 7.7% vs. 78.0 ± 19.9%, p = 0.04). There was improved overall plate-to-bone distance (3D model: 0.7 ± 0.31 mm vs. conventional: 1.3 ± 0.8 mm, p = 0.06). Total intraoperative time was non-significantly decreased with the use of a model (3D model: 726.5 ± 89.1 min vs. conventional: 757.3 ± 84.1 min, p = 0.44). There were no differences in condylar head position or postoperative complications. CONCLUSION Computer-assisted mandibular plating can be used to improve the accuracy of plate contouring. LEVEL OF EVIDENCE 2 Laryngoscope, 134:2182-2186, 2024.
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Affiliation(s)
- Tanya Chen
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
| | - John de Almeida
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Joel C Davies
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Lee S, Quinn L, Fritschi C, Fink AM, Park C, Reutrakul S, Collins EG. Physical Activity After Heart Surgery: Associations With Psychosocial and Sleep Factors. West J Nurs Res 2024; 46:333-343. [PMID: 38533821 DOI: 10.1177/01939459241240432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Heart surgery is an effective intervention for managing heart disease, the leading cause of death globally. After surgery, physical activity is key to improving patients' quality of life and decreasing mortality, but patients are frequently physically inactive after heart surgery. OBJECTIVE This cross-sectional pilot study aimed to examine how psychosocial and sleep factors influenced physical activity in patients after heart surgery. The mediating role of sleep factors between psychosocial factors and physical activity was also examined. METHODS Thirty-three patients who had undergone heart surgery were recruited. Psychosocial and sleep factors and physical activity were measured using an online survey and a wrist-worn ActiGraph for 7 days and nights. RESULTS The participants had heart surgery an average of about 7 years previously. They exceeded the recommended 150 minutes per week of moderate-intensity physical activity for Americans; however, 64% of them showed poor sleep quality (Pittsburgh Sleep Quality Index >5). Higher anxiety and depressive symptoms, lower self-efficacy, and greater sleep disturbances were associated with lower physical activity. Moreover, self-efficacy, sleep duration, sleep disturbance, sleep efficiency, and wake after sleep onset were predictors for physical activity. No mediating role of sleep factors was observed between psychosocial factors and physical activity. CONCLUSIONS Psychosocial and sleep factors should be considered when developing and implementing physical activity strategies for patients after heart surgery. Researchers should examine the relationships among the study variables with larger samples of postsurgical cardiac patients during different periods after heart surgery.
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Affiliation(s)
- Sueyeon Lee
- Marcella Niehoff School of Nursing, Loyola University Chicago, Maywood, IL, USA
| | - Lauretta Quinn
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Cynthia Fritschi
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Anne M Fink
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Chang Park
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | - Sirimon Reutrakul
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Eileen G Collins
- College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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Cui S, Guo Y, Li J, Bian W, Wu W, Zhang W, Zheng Q, Guan H, Wang J, Niu J. Development of a whole spinal MRI-based tumor burden scoring method in participants with multiple myeloma: a pilot study of prognostic significance. Ann Hematol 2024; 103:1665-1673. [PMID: 38326481 DOI: 10.1007/s00277-024-05642-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
The aim of the study was to develop a new whole spinal MRI-based tumor burden scoring method in participants with newly diagnosed multiple myeloma (MM) and to explore its prognostic significance. We prospectively recruited participants with newly diagnosed MM; performed whole spinal MRI (sagittal FSE T1WI, sagittal IDEAL T2WI, and axial FLAIR T2WI) on them; and collected their clinical data, early treatment response, progression-free survival (PFS), and overall survival (OS). We developed a new tumor burden scoring method according to the extent of bone marrow infiltration in five MRI patterns. All participants were divided into good response and poor response groups after four treatment cycles. Univariate, multivariate analyses, and ROC were used to determine the performance of independent predictors. Thresholds for PFS and OS were calculated using X-tile, and their prognostic significance were assessed by Kaplan-Meier. The Kruskal-Wallis H test was used to compare the differences of tumor burden score between the revised International Staging System (R-ISS) stages. The new tumor burden scoring method was used in 62 participants (median score, 12; range, 0-18). The tumor burden score (OR 1.266, p = 0.002) was an independent predictor of poor response and the AUC was 0.838. Higher tumor burden scores were associated with shorter PFS (p = 0.002) and OS (p = 0.011). The tumor burden score was higher in R-ISS-III than in R-ISS-I and R-ISS-II (p = 0.016 and p = 0.006, respectively). The tumor burden score was an excellent predictor of prognosis and may serve as a supplemental marker for R-ISS.
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Affiliation(s)
- Sha Cui
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China
| | - Yinnan Guo
- Department of Pain, Fifth Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jianting Li
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China
| | - Wenjin Bian
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wenqi Wu
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China
| | - Wenjia Zhang
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China
| | - Qian Zheng
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China
| | - Haonan Guan
- GE Healthcare, MR Research China, Beijing, China
| | - Jun Wang
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China
| | - Jinliang Niu
- Department of Radiology, Second Hospital of Shanxi Medical University, 382 Wuyi Road, Taiyuan, Shanxi, China.
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Oriyama S. A 90- followed by a 30-min nap reduces fatigue whereas a 30- followed by a 90-min nap maintains cognitive performance in night work: A randomized crossover-pilot study. Sleep Med 2024; 117:107-114. [PMID: 38522115 DOI: 10.1016/j.sleep.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/11/2023] [Accepted: 03/09/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To investigate the effects of combinations of brief naps (a 90- followed by a 30-min nap vs. a 30- followed by a 90-min nap) on sleep inertia, reducing sleepiness and fatigue, and maintaining performance during night hours. METHODS This randomized, comparative, repeated-measure, cross-over study investigated subjective and cognitive performance in 12 healthy females, evaluated in three experimental nap conditions: 1) from 22:30 to 00:00 and 02:30 to 03:00 (Pre90-NAP group), 2) from 23:30 to 00:00 and 02:30 to 04:00 (Pre30-NAP) group, and 3) no naps (NO-NAP group). Participants' body temperature, psychomotor vigilance task (PVT) and Uchida-Kraepelin test (UKT) scores, and subjective feelings of drowsiness and fatigue were evaluated. Sleep state was determined by an actigraphy monitoring device worn by participants. RESULTS Regardless of timing, both 90-min naps were associated with sleep inertia, and both 30-min naps with minimal sleep inertia. Reaction times were shorter and fewer errors were committed at 2 h post-nap in the Pre30-NAP and Pre90-NAP groups compared with those at the same time in the NO-NAP group. Adding a 90-min nap to a 30-min nap reduced subjective fatigue and shortened reaction times, and adding a 30-min nap to a 90-min nap was effective in maintaining performance, suggesting a synergistic effect. CONCLUSIONS Taking two naps during a night work can mitigate sleepiness and fatigue, and maintain performance. A 90- followed by a 30-min nap reduced fatigue and reaction time, and a 30- followed by a 90-min nap maintained cognitive performance in the early morning.
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Affiliation(s)
- Sanae Oriyama
- Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
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