Now showing items 21-40 of 5417

    • Radiology Medical Student Education 2020: Surveys of the Alliance of Medical Student Educators in Radiology and Medical Students.

      Smith, Elana B; Boscak, Alexis; Friedman, Eric M; Frand, Shterna; Deitte, Lori A; Benefield, Thad; Jordan, Sheryl (Elsevier, 2021-01-27)
      Rationale and objectives: The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant changes to medical student education by disrupting clinical rotations, licensing exams, and residency applications. To evaluate the pandemic's impact and required modifications of radiology medical student courses, the authors developed and administered surveys to Alliance of Medical Student Educators in Radiology (AMSER) faculty and enrolled medical students. The surveys requested feedback and insight about respondents' experiences and innovations. Materials and methods: Anonymous twenty-question and seventeen-question surveys about the pandemic's impact on medical student education were distributed via email to AMSER members and medical students. The surveys consisted of multiple choice, ranking, Likert scale, and open-ended questions. Differences in the Likert score agreement was performed using one-sided Wilcoxon-Mann-Whitney tests. Survey data were collected using SurveyMonkey (San Mateo, California). This study was IRB exempt. Results: The AMSER survey indicated 96% of institutions cancelled medical student courses and 92% resumed with virtual courses, typically general radiology. A total of 64% of faculty enjoyed online teaching, although 82% preferred on-site courses. A total of 62% of students felt an online radiology course was an excellent alternative to an on-site rotation, although 27% disagreed. A total of 69% of students who completed both on-site and online courses preferred the on-site format. Survey-reported innovations and free response comments have been collated as educational resources. Conclusion: Faculty were able to adapt radiology courses to the online environment utilizing interactive lectures, self-directed learning, flipped classroom sessions, and virtual readouts, which were effective for student respondents. Hybrid rotations with on-site and online elements may offer the best of both worlds.
    • Short-Stay Admissions Associated With Large COVID-19 Outbreaks in Maryland Nursing Homes.

      Mattingly, T Joseph; Trinkoff, Alison; Lydecker, Alison D; Kim, Justin J; Yoon, Jung Min; Roghmann, Mary-Claire (SAGE Publications Inc., 2021-12-09)
      At the beginning of the COVID-19 pandemic, some nursing homes (NHs) in Maryland suffered larger outbreaks than others. This study examined how facility characteristics influenced outbreak size. We conducted a retrospective analysis of secondary data from Maryland NHs to identify characteristics associated with large outbreaks, defined as when total resident cases exceeded 10% of licensed beds, from January 1, 2020, through July 1, 2020. Our dataset was unique in its inclusion of short-stay residents as a measure of resident type and family satisfaction as a measure of quality. Facility characteristics were collected prior to 2020. Like other studies, we found that large outbreaks were more likely to occur in counties with high cumulative incidence of COVID-19, and in NHs with more licensed beds or fewer daily certified nursing assistant (CNA) hours. We also found that NHs with a greater proportion of short-stay residents were more likely to have large outbreaks, even after adjustment for other facility characteristics. Lower family satisfaction was not significantly associated with large outbreaks after adjusting for CNA hours. Understanding the characteristics of NHs with large COVID-19 outbreaks can guide facility re-structuring to prevent the spread of respiratory infections in future pandemics.
    • Wear Behavior and Surface Quality of Dental Bioactive Ions-Releasing Resins Under Simulated Chewing Conditions.

      Garcia, Isadora Martini; Balhaddad, Abdulrahman A; Aljuboori, Noorhan; Ibrahim, Maria Salem; Mokeem, Lamia; Ogubunka, Akudo; Collares, Fabrício Mezzomo; de Melo, Mary Anne Sampaio (Frontiers Media S.A., 2021-02-12)
      Bioactive materials can reduce caries lesions on the marginal sealed teeth by providing the release of ions, such as calcium, phosphate, fluoride, zinc, magnesium, and strontium. The presence of such ions affects the dissolution balance of hydroxyapatite, nucleation, and epitaxial growth of its crystals. Previous studies mostly focused on the ion-releasing behavior of bioactive materials. Little is known about their wear behavior sealed tooth under mastication. This study aimed to evaluate the wear behavior and surface quality of dental bioactive resins under a simulated chewing model and compare them with a resin without bioactive agents. Three bioactive resins (Activa, BioCoat, and Beautifil Flow-Plus) were investigated. A resin composite without bioactive agents was used as a control group. Each resin was applied to the occlusal surface of extracted molars and subjected to in vitro chewing simulation model. We have assessed the average surface roughness (Ra), maximum high of the profile (Rt), and maximum valley depth (Rv) before and after the chewing simulation model. Vickers hardness and scanning electron microscopy (SEM) also analyzed the final material surface quality). Overall, all groups had increased surface roughness after chewing simulation. SEM analysis revealed a similar pattern among the materials. However, the resin with polymeric microcapsules doped with bioactive agents (BioCoat) showed increased surface roughness parameters. The material with Surface Pre-reacted Glass Ionomer (Beautifil Flow-Plus) showed no differences compared to the control group and improved microhardness. The addition of bioactive agents may influence surface properties, impairing resin composites' functional and biological properties. Future studies are encouraged to analyze bioactive resin composites under high chemical and biological challenges in vitro with pH cycles or in situ models.
    • Rehabilitation Care at the Time of Coronavirus Disease-19 (COVID-19) Pandemic: A Scoping Review of Health System Recommendations

      Negm, Ahmed M.; Salopek, Adrian; Zaide, Mashal; Meng, Victoria J.; Prada, Carlos; Chang, Yaping; Zanwar, Preeti; Santos, Flavia H.; Philippou, Elena; Rosario, Emily R.; et al. (Frontiers Media SA, 2022-01-04)
      Purpose: The coronavirus disease-19 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. COVID-19, caused by SARS-CoV-2 has imposed a significant burden on health care systems, economies, and social systems in many countries around the world. The provision of rehabilitation services for persons with active COVID-19 infection poses challenges to maintaining a safe environment for patients and treating providers. Materials and Methods: Established frameworks were used to guide the scoping review methodology. Medline, Embase, Pubmed, CINAHL databases from inception to August 1, 2020, and prominent rehabilitation organizations' websites were searched. Study Selection: We included articles and reports if they were focused on rehabilitation related recommendations for COVID-19 patients, treating providers, or the general population. Data Extraction: Pairs of team members used a pre-tested data abstraction form to extract data from included full-text articles. The strength and the quality of the extracted recommendations were evaluated by two reviewers using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results: We retrieved 6,468 citations, of which 2,086 were eligible for review, after duplicates were removed. We excluded 1,980 citations based on title and abstract screening. Of the screened full-text articles, we included all 106 studies. A summary of recommendations is presented. We assessed the overall evidence to be strong and of fair quality. Conclusion: The rehabilitation setting, and processes, logistics, and patient and healthcare provider precaution recommendations identified aim to reduce the spread of SARS-CoV-2 infection and ensure adequate and safe rehabilitation services, whether face-to-face or through teleservices. The COVID-19 pandemic is rapidly changing. Further updates will be needed over time in order to incorporate emerging best evidence into rehabilitation guidelines.
    • 2021 VIRTUAL CONGRESS ABSTRACTS P.156: Transcriptomic Profile in Pancreas Biopsies for Monitoring Graft Rejection

      Aguiar, Pedro Ventura; Ramirez-Bajo, Maria Jose; Sanchez Salom, Laura; Roufosse, Candice; Cuatrecasas, Miriam; Rovira, Jordi; Bañón-Maneus, Elisenda; Fondevila, Constantino; Campistol, Josep M.; Uva, Pablo; et al. (Lippincott Williams and Wilkins, 2021-12-01)
    • 2021 VIRTUAL CONGRESS ABSTRACTS 306.8: Impact of Alemtuzumab Induction on Pancreas Transplant Outcomes

      Haririan, Abdolreza; Booth, Ian; Masters, Brian; Casale, Jillian; Scalea, Joseph; Drachenberg, Cinthia (Lippincott Williams and Wilkins, 2021-12-01)
    • 2021 VIRTUAL CONGRESS ABSTRACTS 406.1: An Initial Analysis of the Baseline Levels of dd-cfDNA After Pancreas Transplantation: A Prospective Study From High-volume Centers in the United States

      Yoo, Ashley; Qian, Ian; Riedel, Alexandria; Bartosic, Amanda; Soltani, Rudi; Nduanya, Ojel; Omidi, Marziyeh; Odorico, Jon S.; Cooper, Matthew; Bromberg, Jonathan S.; et al. (Lippincott Williams and Wilkins, 2021-12-01)
    • A N-(4-chlorophenyl)-γ-amino acid derivatives exerts in vitro anticancer activity on non-small cell lung carcinoma cells and enhances citosine arabinoside (AraC)-induced cell death via mitochondria-targeted pathway

      Kavaliauskas, Povilas; Žukauskas, Šarūnas; Anusevičius, Kazimieras; Balandis, Benas; Vaickelionienė, Rita; Petraitis, Vidmantas; Mickevičius, Vytautas (Elsevier, 2021-01-01)
      A Non-Small Cell Lung Cancer (NSCLC) is among the leading cause of cancer-associated morbidity and mortality worldwide. Novel treatment and drug repurposing strategies are needed. Cytosine arabinoside (AraC) is an S-phase inhibitor historically used for the treatment of leukemia. Previously AraC was not investigated as a therapeutic option for NSCLC. We explored a novel adjuvant therapy concept in vitro targeting S-phase and mitochondrial pathways. A synthetic pathway to generate novel mitochondria damaging N-(4-chlorophenyl)-γ-amino acid derivatives bearing an azole, diazole and triazole moieties was described. The resulting compounds were evaluated for their anticancer activity on well described A549 cells. Five compounds demonstrated convincing anticancer activity comparable to cytosine arabinoside (AraC). The most promising compound 7g (IC50=38.38 µM) bearing 3,4-dichlorophenyl moiety was able to induce the mitochondrial injury, leading to significant (p<0.05) ROS production and inhibition of ATP synthesis. 7g synergized with AraC and significantly decreased A549 viability in comparison to AraC and 7g monotherapy or UC. The cytotoxic effect on A549 viability after AraC combination with 7g was similar to doxorubicin monotherapy. These results suggest that 7g could be potentially explored adjuvant enhancing the activity of standard chemotherapeutic agents. Further studies are needed to better understand the safety, efficacy, and precise cellular targets of of N-(4-chlorophenyl)-γ-amino acids.
    • Conolidine: A Novel Plant Extract for Chronic Pain

      Edinoff, Amber N.; Patel, Akash S.; Baker, Mitchell W.; Lawson, Jesse; Wolcott, Christopher; Cornett, Elyse M.; Sadegi, Kambiz; Kaye, Adam M.; Kaye, Alan D. (Kowsar Publishing Company, 2021-12-01)
      Pain, the most common symptom reported among patients in the primary care setting, is complex to manage. Opioids are among the most potent analgesics agents for managing pain. Since the mid-1990s, the number of opioid prescriptions for the management of chronic non-cancer pain (CNCP) has increased by more than 400%, and this increased availability has significantly contributed to opioid diversion, overdose, tolerance, dependence, and addiction. Despite the questionable effectiveness of opioids in managing CNCP and their high rates of side effects, the absence of available alternative medications and their clinical limitations and slower onset of action has led to an overreliance on opioids. Conolidine is an indole alkaloid derived from the bark of the tropical flowering shrub Tabernaemontana divaricate used in traditional Chinese, Ayurvedic, and Thai medicine. Conolidine could represent the beginning of a new era of chronic pain management. It is now being investigated for its effects on the atypical chemokine receptor (ACK3). In a rat model, it was found that a competitor molecule binding to ACKR3 resulted in inhibition of ACKR3’s inhibitory activity, causing an overall increase in opiate receptor activity. Although the identification of conolidine as a potential novel analgesic agent provides an additional avenue to address the opioid crisis and manage CNCP, further studies are necessary to understand its mechanism of action and utility and efficacy in managing CNCP.
    • Effect of long-term maximum strength training on explosive strength, neural, and contractile properties.

      Balshaw, Thomas G; Massey, Garry J; Maden-Wilkinson, Thomas M; Lanza, Marcel B; Folland, Jonathan P (Wiley-Blackwell, 2022-01-03)
      The purpose of this cross-sectional study was to compare explosive strength and underpinning contractile, hypertrophic, and neuromuscular activation characteristics of long-term maximum strength-trained (LT-MST; ie, ≥3 years of consistent, regular knee extensor training) and untrained individuals. Sixty-three healthy young men (untrained [UNT] n = 49, and LT-MST n = 14) performed isometric maximum and explosive voluntary, as well as evoked octet knee extension contractions. Torque, quadriceps, and hamstring surface EMG were recorded during all tasks. Quadriceps anatomical cross-sectional area (QACSAMAX ; via MRI) was also assessed. Maximum voluntary torque (MVT; +66%) and QACSAMAX (+54%) were greater for LT-MST than UNT ([both] p < 0.001). Absolute explosive voluntary torque (25-150 ms after torque onset; +41 to +64%; [all] p < 0.001; 1.15≤ effect size [ES]≤2.36) and absolute evoked octet torque (50 ms after torque onset; +43, p < 0.001; ES = 3.07) were greater for LT-MST than UNT. However, relative (to MVT) explosive voluntary torque was lower for LT-MST than UNT from 100 to 150 ms after contraction onset (-11% to -16%; 0.001 ≤ p ≤ 0.002; 0.98 ≤ ES ≤ 1.11). Relative evoked octet torque 50 ms after onset was lower (-10%; p < 0.001; ES = 1.14) and octet time to peak torque longer (+8%; p = 0.001; ES = 1.18) for LT-MST than UNT indicating slower contractile properties, independent from any differences in torque amplitude. The greater absolute explosive strength of the LT-MST group was attributable to higher evoked explosive strength, that in turn appeared to be due to larger quadriceps muscle size, rather than any differences in neuromuscular activation. In contrast, the inferior relative explosive strength of LT-MST appeared to be underpinned by slower intrinsic/evoked contractile properties.
    • Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) Statement: Updated Reporting Guidance for Health Economic Evaluations.

      Husereau, Don; Drummond, Michael; Augustovski, Federico; de Bekker-Grob, Esther; Briggs, Andrew H; Carswell, Chris; Caulley, Lisa; Chaiyakunapruk, Nathorn; Greenberg, Dan; Loder, Elizabeth; et al. (Adis, 2022-01-11)
      Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, as well as the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as health care, public health, education, social care, etc). This summary article presents the new CHEERS 2022 28-item checklist and recommendations for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer reviewed journals as well as the peer reviewers and editors assessing them for publication. However, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, as there is an increasing emphasis on transparency in decision making. © 2021, The Author(s).
    • A core outcome set for damage control laparotomy via modified Delphi method.

      Byerly, Saskya; Nahmias, Jeffry; Stein, Deborah M; Haut, Elliott R; Smith, Jason W; Gelbard, Rondi; Ziesmann, Markus; Boltz, Melissa; Zarzaur, Ben L; Bala, Miklosh; et al. (BMJ Publishing Group, 2022-01-04)
      Objectives Damage control laparotomy (DCL) remains an important tool in the trauma surgeon's armamentarium. Inconsistency in reporting standards have hindered careful scrutiny of DCL outcomes. We sought to develop a core outcome set (COS) for DCL clinical studies to facilitate future pooling of data via meta-analysis and Bayesian statistics while minimizing reporting bias. Methods A modified Delphi study was performed using DCL content experts identified through Eastern Association for the Surgery of Trauma (EAST) 'landmark' DCL papers and EAST ad hoc COS task force consensus. Results Of 28 content experts identified, 20 (71%) participated in round 1, 20/20 (100%) in round 2, and 19/20 (95%) in round 3. Round 1 identified 36 potential COS. Round 2 achieved consensus on 10 core outcomes: mortality, 30-day mortality, fascial closure, days to fascial closure, abdominal complications, major complications requiring reoperation or unplanned re-exploration following closure, gastrointestinal anastomotic leak, secondary intra-abdominal sepsis (including anastomotic leak), enterocutaneous fistula, and 12-month functional outcome. Despite feedback provided between rounds, round 3 achieved no further consensus. Conclusions Through an electronic survey-based consensus method, content experts agreed on a core outcome set for damage control laparotomy, which is recommended for future trials in DCL clinical research. Further work is necessary to delineate specific tools and methods for measuring specific outcomes. Level of evidence V, criteria
    • Fluid Shear Stress Induced Sclerostin Degradation and CaMKII Activation in Osteocytes.

      Gould, Nicole R; Leser, Jenna M; Torre, Olivia M; Khairallah, Ramzi J; Ward, Christopher W; Stains, Joseph P (Bio-protocol LLC, 2021-12-05)
      Bone is a dynamic tissue that adapts to changes in its mechanical environment. Mechanical stimuli pressurize interstitial fluid in the lacunar-canalicular system within the bone matrix, causing fluid shear stress (FSS) across bone embedded, mechano-sensitive osteocytes. Therefore, modeling this mechanical stimulus in vitro is vital for identifying mechano-transduction cascades that contribute to the regulation of mechano-responsive proteins, such as the Wnt/β-catenin antagonist, sclerostin, which is reduced in response to FSS. Recently, we reported the rapid post-translational degradation of sclerostin protein in bone cells following FSS. Given the fundamental nature of sclerostin to bone physiology and the nuances of studying its rapid post-translational control, here, we detail our FSS protocol, and adaptations that can be made, to stimulate Ocy454 osteocyte-like cells to study sclerostin protein in vitro. While this protocol is optimized for detecting sclerostin degradation by western blot, this protocol can be adapted to examine transcriptional changes with RT-qPCR, cellular dynamics with live cell imaging, or secreted factors in the FSS buffer. This protocol utilizes 3D-printed FSS tips that are compatible with commercially available 96-well plates, allowing for high experimental accessibility, versatility, and throughput. However, this protocol can be adapted for any FSS chamber. It can also be combined with pharmacological inhibitors or genetic manipulations to interrogate the role of specific cellular components. In all, this experimental set-up and protocol is highly adaptable to allow for many experimental outcomes to examine many aspects of cell mechano-transduction.
    • Maternal depressive symptoms, attendance of sessions and reduction of home safety problems in a randomized toddler safety promotion intervention trial: A latent class analysis.

      Wang, Yan; Zhu, Eric; Hager, Erin R; Black, Maureen M (Public Library of Science, 2022-01-19)
      Objective Little is known about the association between maternal depressive symptoms and attendance at safety promotion interventions. This study used latent class analysis (LCA) to identify the profile of attendance within a toddler safety intervention and assessed its relation with maternal depressive symptoms at baseline and reduction of home safety problems over time, separately. Methods The analytic sample included 91 mothers of toddlers (mean maternal age 28.16 years) who were assigned to the safety promotion intervention group as part of a randomized trial and assessed at baseline, 6-month and 12-month follow-ups. Using LCA, we classified mothers into low and high attendance classes based on their attendance at 8 intervention sessions. We assessed maternal depressive symptoms with the Beck Depression Inventory (BDI) and home safety problems with a 9-item home safety problem observation. Results The mothers were classified into low attendance (45%) and high attendance classes (55%). The posterior probability of attending each session ranged from 0–0.29 for the low attendance class and 0.68–0.92 for the high attendance class. Each one unit increase of BDI sum score at baseline was associated with an 8% reduced odds of being in the high attendance class (aOR = 0.92, 95% CI: 0.86, 1.00, p = 0.037). The home safety problem score reduction was greater among high attendance class participants than low attendance class participants at the 6-month follow-up (b = -1.15, 95% CI:-2.09, -0.20, p = 0.018). Conclusion Maternal depressive symptoms were associated with the reduced probability of maternal attendance at toddler safety promotion sessions; high session attendance was related to greater reduction of toddler home safety problems. Identifying risk factors for maternal low attendance to interventions and developing strategies to promote attendance should lead to reductions in home safety problems and reductions in unintentional injuries among young children.
    • Treatment for Patients With Early Stage Adenosquamous Lung Cancer.

      He, Jiaxi; Li, Shuben; Pan, Hui; He, Jianxing (Elsevier, 2020-03-04)
      Introduction: Adenosquamous lung cancer (ASC) is a rare type of NSCLC with poor prognosis. There is no consensus on the necessity of adjuvant chemotherapy and the selection of surgical procedures for patients with early stage lung cancer. Few studies have investigated the treatment for early stage ASC. Methods: All cases of TNM stage I ASC as per the seventh edition of the American Joint Committee on Cancer staging system were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2016. The prognostic factors of the primary cohort were identified. Clinical characteristics, first-line treatments, surgical procedures, and survival data, including overall survival and cancer-specific survival, were analyzed. Results: A total of 1251 patients were included. The mean age of the patients was 70 years (±9.5 y). Male and white patients accounted for larger proportions. There were 656 and 595 patients with stages IA and IB, respectively. The mean tumor size was 26.2 mm (±10.7 mm). With respect to the treatment, 139 patients who received only chemotherapy had the worst prognosis. Similar outcomes were observed in both the surgery and adjuvant therapy groups. Nevertheless, adjuvant chemotherapy could improve survival outcomes of patients with a tumor size of 4 to 5 cm. Of the 1075 patients who underwent surgery, there were 224 cases of sublobar resection, 834 cases of lobectomy, and 17 cases of extended or sleeve lobectomy. The results revealed that patients who underwent lobectomy had better prognosis. Conclusions: Early stage ASC has a poor prognosis. Adjuvant chemotherapy was found to have no considerable benefit in patients with stage I disease (eighth edition). Lobectomy or other radical surgeries are recommended as they can improve overall survival of patients with ASC. © 2020 The Authors
    • Proteomic differences among patients with heart failure taking furosemide or torsemide.

      Cooper, Lauren B; Bruce, Scott; Psotka, Mitchell; Mentz, Robert; Bell, Rachel; Seliger, Stephen L; O'Connor, Christopher; deFilippi, Christopher (Wiley-Blackwell, 2022-01-11)
      Of 78 subjects, 55 (71%) were treated with furosemide and 23 (29%) with torsemide, and 25 provided a urine sample (15 treated with furosemide, 10 with torsemide). Patients taking torsemide were older (68 vs 64 years) with a lower mean eGFR (46 vs 54 ml/min/1.73 m2 ), a higher proportion were women (39% vs 24%) and Black (43% vs 27%). In plasma, levels of hs-cTnT, NT-proBNP, and hsCRP were not significantly different between groups. In urine, there were significant differences in urinary albumin, β-2M, and NGAL, with higher levels in the torsemide-treated patients. Of 184 proteins testing in Olink panels, in plasma, 156 (85%) were higher in patients taking torsemide but none were significantly different after correcting for false discovery.
    • Implementation of Client-Centered Care Coordination for HIV Prevention with Black Men Who Have Sex with Men: Activities, Personnel Costs, and Outcomes-HPTN 073.

      Whitfield, Darren L; Nelson, LaRon E; Komárek, Arnošt; Turner, DeAnne; Ni, Zhao; Boyd, Donte T; Taggart, Tamara; Ramos, S Raquel; Wilton, Leo; Beauchamp, Geetha G; et al. (Springer Nature, 2022-01-08)
      Background: Black men who have sex with men (MSM) experience disproportionate rates of HIV infection in the USA, despite being no more likely to engage in sexual risk behaviors than other MSM racial/ethnic groups. HIV pre-exposure prophylaxis (PrEP) has been shown to reduce risk of HIV acquisition; however, rates of PrEP use among Black MSM remain low. Clinical, psychosocial, and structural factors have been shown to impact PrEP use and adherence among Black MSM. Care coordination of HIV prevention services has the potential to improve PrEP use and adherence for Black MSM, as it has been shown to improve HIV-related care outcomes among people living with HIV. Methods: Client-centered care coordination (C4) is a multi-level intervention designed to address clinical, psychosocial, and structural barriers to HIV prevention services for Black MSM within HPTN 073, a PrEP demonstration project among Black MSM in three cities in the USA. The current study examined the implementation process of C4, specifically investigating the activities, cost, time, and outcomes associated with the C4 intervention. Results: On average, participants engaged in five care coordination encounters. The vast majority of care coordination activities were conducted by counselors, averaging 30 min per encounter. The cost of care coordination was relatively low with a mean cost of $8.70 per client encounter. Conclusion: Although client-centered care coordination was initially implemented in well-resourced communities with robust HIV research and service infrastructure, our findings suggest that C4 can be successfully implemented in resource constrained communities. © 2021, The Author(s).
    • Clinical Outcomes After Proton Beam Therapy for Locally Advanced Non-Small Cell Lung Cancer: Analysis of a Multi-institutional Prospective Registry

      Jongen, Aurélien; Charlier, Florian; Baker, Kelsey; Chang, John; Hartsell, William; Laramore, George; Mohindra, Pranshu; Moretti, Luigi; Redman, Mary; Rosen, Lane; et al. (Elsevier, 2022-01-01)
      Purpose: For most disease sites, level 1 evidence is lacking for proton beam therapy (PBT). By identifying target populations that would benefit most from PBT, prospective registries could overcome many of the challenges in clinical trial enrollment. Herein, we report clinical outcomes of patients treated with PBT for locally advanced non-small cell lung cancer (LA-NSCLC). Methods and Materials: Data were obtained from the multi-institutional prospective database of the Proton Collaborative Group (PCG). Inclusion criteria of our study were stage III de novo or recurrent LA-NSCLC, use of PBT, and availability of follow-up data. Overall survival (OS) time was calculated from the start of treatment until death or last follow-up. Kaplan-Meier curves were generated for groups of interest and compared with log-rank tests. Cox regression modeling was used to evaluate the multivariate association between selected covariates and OS. Results: A total of 195 patients were included in the analysis. PBT was given with a median equivalent dose in 2 Gy fractions (EQD2) of 63.8 Gy (relative biological effectiveness). Pencil beam scanning was used in 20% of treatments. Treatment-related grade 3 adverse events were rare: 1 pneumonitis, 2 dermatitis, and 3 esophagitis. No grade 4 events were reported. Two cardiac-related grade 5 events occurred in patients with multiple risk factors. The median follow-up time for living patients was 37.1 months and the median OS was 19.0 months. On multivariate analysis, good performance status (hazard ratio, 0.27; [95% confidence interval, 0.15-0.46]; P < .0001), pencil beam scanning use (0.55; [0.31-0.97]; P = .04), and increased EQD2 (0.80; [0.71-0.90] - per 10 Gy increase; P = .0002) were associated with decreased mortality. Conclusions: PBT appears to yield low rates of adverse events with an OS similar to other retrospective studies on PBT for LA-NSCLC. PBS use and increased EQD2 can potentially improve OS. © 2021 The Authors
    • Prevalence and Risk Factors of Neurologic Manifestations in Hospitalized Children Diagnosed with Acute SARS-CoV-2 or MIS-C

      Fink, Ericka L.; Robertson, Courtney L.; Wainwright, Mark S.; Roa, Juan D.; Lovett, Marlina E.; Stulce, Casey; Yacoub, Mais; Potera, Renee M.; Zivick, Elizabeth; Holloway, Adrian; et al. (Elsevier, 2022-03-01)
      Background: Our objective was to characterize the frequency, early impact, and risk factors for neurological manifestations in hospitalized children with acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or multisystem inflammatory syndrome in children (MIS-C). Methods: Multicenter, cross-sectional study of neurological manifestations in children aged <18 years hospitalized with positive SARS-CoV-2 test or clinical diagnosis of a SARS-CoV-2-related condition between January 2020 and April 2021. Multivariable logistic regression to identify risk factors for neurological manifestations was performed. Results: Of 1493 children, 1278 (86%) were diagnosed with acute SARS-CoV-2 and 215 (14%) with MIS-C. Overall, 44% of the cohort (40% acute SARS-CoV-2 and 66% MIS-C) had at least one neurological manifestation. The most common neurological findings in children with acute SARS-CoV-2 and MIS-C diagnosis were headache (16% and 47%) and acute encephalopathy (15% and 22%), both P < 0.05. Children with neurological manifestations were more likely to require intensive care unit (ICU) care (51% vs 22%), P < 0.001. In multivariable logistic regression, children with neurological manifestations were older (odds ratio [OR] 1.1 and 95% confidence interval [CI] 1.07 to 1.13) and more likely to have MIS-C versus acute SARS-CoV-2 (OR 2.16, 95% CI 1.45 to 3.24), pre-existing neurological and metabolic conditions (OR 3.48, 95% CI 2.37 to 5.15; and OR 1.65, 95% CI 1.04 to 2.66, respectively), and pharyngeal (OR 1.74, 95% CI 1.16 to 2.64) or abdominal pain (OR 1.43, 95% CI 1.03 to 2.00); all P < 0.05. Conclusions: In this multicenter study, 44% of children hospitalized with SARS-CoV-2-related conditions experienced neurological manifestations, which were associated with ICU admission and pre-existing neurological condition. Posthospital assessment for, and support of, functional impairment and neuroprotective strategies are vitally needed.
    • A personalized biomedical risk assessment infographic for people who smoke with COPD: a qualitative study.

      Gupta, Samir; Panchal, Puru; Sadatsafavi, Mohsen; Ghanouni, Parisa; Sin, Don; Pakhale, Smita; To, Teresa; Zafari, Zafar; Nimmon, Laura (Springer Nature, 2022-01-06)
      Background: Chronic obstructive pulmonary disease (COPD) causes 3 million deaths each year, yet 38% of COPD patients continue to smoke. Despite proof of effectiveness and universal guideline recommendations, smoking cessation interventions are underused in practice. We sought to develop an infographic featuring personalized biomedical risk assessment through future lung function decline prediction (with vs without ongoing smoking) to both prompt and enhance clinician delivery of smoking cessation advice and pharmacotherapy, and augment patient motivation to quit. Methods: We recruited patients with COPD and pulmonologists from a quaternary care center in Toronto, Canada. Infographic prototype content and design was based on best evidence. After face validation, the prototype was optimized through rapid-cycle design. Each cycle consisted of: (1) infographic testing in a moderated focus group and a clinician interview (recorded/transcribed) (with questionnaire completion); (2) review of transcripts for emergent/critical findings; and (3) infographic modifications to address findings (until no new critical findings emerged). We performed iterative transcript analysis after each cycle and a summative qualitative transcript analysis with quantitative (descriptive) questionnaire analysis. Results: Stopping criteria were met after 4 cycles, involving 20 patients (58% male) and 4 pulmonologists (50% male). The following qualitative themes emerged: Tool content (infographic content preferences); Tool Design (infographic design preferences); Advantages of Infographic Messaging (benefits of an infographic over other approaches); Impact of Tool on Determinants of Smoking Cessation Advice Delivery (impact on barriers and enablers to delivery of smoking cessation advice in practice); and Barriers and Enablers to Quitting (impact on barriers and enablers to quitting). Patient Likert scale ratings of infographic content and format/usability were highly positive, with improvements in scores for 20/21 questions through the design process. Providers scored the infographic at 77.8% (“superior”) on the Suitability Assessment of Materials questionnaire. Conclusions: We developed a user preference-based personalized biomedical risk assessment infographic to drive smoking cessation in patients with COPD. Our findings suggest that this tool could impact behavioural determinants of provider smoking-cessation advice delivery, while increasing patient quit motivation. Impacts of the tool on provider care, patient motivation to quit, and smoking cessation success should now be evaluated in real-world settings. © 2021, The Author(s).