Now showing items 1-20 of 16353

    • Haploidentical vs sibling, unrelated, or cord blood hematopoietic cell transplantation for acute lymphoblastic leukemia.

      Wieduwilt, Matthew J; Metheny, Leland; Zhang, Mei-Jie; Wang, Hai-Lin; Estrada-Merly, Noel; Marks, David I; Al-Homsi, A Samer; Muffly, Lori; Chao, Nelson; Rizzieri, David; et al. (Elsevier, 2022-01)
      The role of haploidentical hematopoietic cell transplantation (HCT) using posttransplant cyclophosphamide (PTCy) for acute lymphoblastic leukemia (ALL) is being defined. We performed a retrospective, multivariable analysis comparing outcomes of HCT approaches by donor for adults with ALL in remission. The primary objective was to compare overall survival (OS) among haploidentical HCTs using PTCy and HLA-matched sibling donor (MSD), 8/8 HLA-matched unrelated donor (MUD), 7 /8 HLA-MUD, or umbilical cord blood (UCB) HCT. Comparing haploidentical HCT to MSD HCT, we found that OS, leukemia-free survival (LFS), nonrelapse mortality (NRM), relapse, and acute graft-versus-host disease (aGVHD) were not different but chronic GVHD (cGVHD) was higher in MSD HCT. Compared with MUD HCT, OS, LFS, and relapse were not different, but MUD HCT had increased NRM (hazard ratio [HR], 1.42; P = .02), grade 3 to 4 aGVHD (HR, 1.59; P = .005), and cGVHD. Compared with 7/8 UD HCT, LFS and relapse were not different, but 7/8 UD HCT had worse OS (HR, 1.38; P = .01) and increased NRM (HR, 2.13; P ≤ .001), grade 3 to 4 aGVHD (HR, 1.86; P = .003), and cGVHD (HR, 1.72; P ≤ .001). Compared with UCB HCT, late OS, late LFS, relapse, and cGVHD were not different but UCB HCT had worse early OS (≤18 months; HR, 1.93; P < .001), worse early LFS (HR, 1.40; P = .007) and increased incidences of NRM (HR, 2.08; P < .001) and grade 3 to 4 aGVHD (HR, 1.97; P < .001). Haploidentical HCT using PTCy showed no difference in survival but less GVHD compared with traditional MSD and MUD HCT and is the preferred alternative donor HCT option for adults with ALL in complete remission.
    • Providing support in a pandemic: A medical student telehealth service for ambulatory patients with COVID-19

      Zhang, Annie; GoodSmith, Matthew; Server, Steven; Uddin, Sophia; McNulty, Moira; Sherer, Renslow; Lio, Jonathan (Elsevier, 2022-03-01)
      During the early months of the COVID-19 pandemic, when health systems were overwhelmed with surging hospitalizations and a novel virus, many ambulatory patients diagnosed with COVID-19 lacked guidance and support as they convalesced at home. This case report offers insight into the implementation of a telehealth service utilizing third- and fourth-year medical students to provide follow-up to ambulatory patients diagnosed with COVID-19. The service was evaluated using medical student surveys and retrospective chart review to assess the clinical and social needs of patients during the spring of 2020. Students assessed symptoms for 416 patients with COVID-19 from April 8 to May 20 and provided clinical information and resources. Eighteen percent of these patients sought higher levels of medical care, in part from student referrals. Three key implementation lessons from this experience that may be relevant for others include: 1) Vulnerable patient populations face unique stressors exacerbated by the pandemic and may benefit from intensive follow-up after COVID-19 diagnosis to address both medical and social needs; 2) Medical students can play value-added roles in providing patient education to prevent the spread of COVID-19, assisting patients with escalating care or resource connection, and providing emotional support to those who have lost loved ones; 3) Continuous re-assessment of the intervention was important to address evolving patient needs during the COVID-19 outbreak. Future work should focus on identifying high-risk patient populations and tailoring follow-up interventions to meet the unique needs of these patient populations.
    • Down-regulation of the brain-specific cell-adhesion molecule contactin-3 in tuberous sclerosis complex during the early postnatal period.

      Korotkov, Anatoly; Luinenburg, Mark J; Romagnolo, Alessia; Zimmer, Till S; van Scheppingen, Jackelien; Bongaarts, Anika; Broekaart, Diede W M; Anink, Jasper J; Mijnsbergen, Caroline; Jansen, Floor E; et al. (Springer Nature, 2022-01-15)
      Background: The genetic disorder tuberous sclerosis complex (TSC) is frequently accompanied by the development of neuropsychiatric disorders, including autism spectrum disorder and intellectual disability, with varying degrees of impairment. These co-morbidities in TSC have been linked to the structural brain abnormalities, such as cortical tubers, and recurrent epileptic seizures (in 70–80% cases). Previous transcriptomic analysis of cortical tubers revealed dysregulation of genes involved in cell adhesion in the brain, which may be associated with the neurodevelopmental deficits in TSC. In this study we aimed to investigate the expression of one of these genes – cell-adhesion molecule contactin-3. Methods: Reverse transcription quantitative polymerase chain reaction for the contactin-3 gene (CNTN3) was performed in resected cortical tubers from TSC patients with drug-resistant epilepsy (n = 35, age range: 1–48 years) and compared to autopsy-derived cortical control tissue (n = 27, age range: 0–44 years), as well as by western blot analysis of contactin-3 (n = 7 vs n = 7, age range: 0–3 years for both TSC and controls) and immunohistochemistry (n = 5 TSC vs n = 4 controls). The expression of contactin-3 was further analyzed in fetal and postnatal control tissue by western blotting and in-situ hybridization, as well as in the SH-SY5Y neuroblastoma cell line differentiation model in vitro. Results: CNTN3 gene expression was lower in cortical tubers from patients across a wide range of ages (fold change = − 0.5, p < 0.001) as compared to controls. Contactin-3 protein expression was lower in the age range of 0–3 years old (fold change = − 3.8, p < 0.001) as compared to the age-matched controls. In control brain tissue, contactin-3 gene and protein expression could be detected during fetal development, peaked around birth and during infancy and declined in the adult brain. CNTN3 expression was induced in the differentiated SH-SY5Y neuroblastoma cells in vitro (fold change = 6.2, p < 0.01). Conclusions: Our data show a lower expression of contactin-3 in cortical tubers of TSC patients during early postnatal period as compared to controls, which may affect normal brain development and might contribute to neuropsychiatric co-morbidities observed in patients with TSC. © 2022, The Author(s).
    • Virtual Face to Face with Dr. Bruce Jarrell: Vaccines And The Omicron Surge

      Jarrell, Bruce E.; Neuzil, Kathleen M; Likowski, Alex (2022-01-13)
    • Leadership Strategies to Prevent Employee Substance Abuse Relapse and Optimize Business Viability

      Narine, John; Aldridge-Anthony, Lakisha (2021-06)
      Employees, who relapse from substance abuse, precipitate unnecessary costs to employers through absenteeism, production loss, turnover, and health care. Addicted employees who relapse are becoming a growing concern as substance abuse relapse and overdose rates have significantly increased during the COVID-19 Pandemic. The purpose of this qualitative phenomenological study is to explore strategies leaders use to understand the needs of addicted employees during a crisis, reduce employee substance abuse relapse rates, and ensure business viability. The conceptual framework for this study is Maslow’s hierarchy of needs, Goleman’s emotional intelligence theory, and emotional sobriety. The population for this study includes 10 leaders located in the United States. The participants were chosen using purposeful snowball sampling and were asked 11 open-ended questions via qualitative interviews to gather rich and detailed data to saturate this study. Through data analysis, the researcher uncovered four themes: (a) meeting employees where they are; (b) building personal connection through vulnerability; (c) diversity and inclusion; (d) strategies formed through education and practical experience. Analysis of the findings revealed that leaders who participated in addiction education and utilized individualized consideration prevented relapse and improved organizational performance by addressing employee needs. The results of this study may be adopted by leaders to effectively retain an engaged and performing workforce by enhancing corporate policy and practices related to addicted employees.
    • Rising Through Resilience: Jeff Gorter of R3 Continuum On The Five Things You Can Do To Become More Resilient

      Clemente, Savio; Gorter, Jeff (Authority Magazine, 2021-11-22)
      Start with the basics. In times of stress, begin with making sure you are eating healthy food, staying hydrated, maintaining a regular sleep schedule, and exercising moderately to keep your body balanced. This may sound obvious, but there is a common misconception that the bigger the challenge, the bigger the solution needs to be. Simple self-care — while it may seem inadequate — is an essential first step. Otherwise, we’re exhausted and have impaired ability to respond to whatever comes next. Resilience has been described as the ability to withstand adversity and bounce back from difficult life events. Conditions are not easy right now. How do we develop greater resilience to withstand the challenges that keep being thrown at us? In this interview series, we are talking to mental health experts, authors, resilience experts, coaches and business leaders who can talk about how we can develop stronger resilience to improve our lives. As a part of this series, I had the pleasure of interviewing Jeff Gorter, MSW, LCSW.
    • Immune correlates analysis of the mRNA-1273 COVID-19 vaccine efficacy clinical trial.

      Gilbert, Peter B; Montefiori, David C; McDermott, Adrian B; Fong, Youyi; Benkeser, David; Deng, Weiping; Zhou, Honghong; Houchens, Christopher R; Martins, Karen; Jayashankar, Lakshmi; et al. (American Association for the Advancement of Science, 2021-11-23)
    • Using Polyvagal Theory to Regulate Workplace Stress During Covid - 19

      Ashley, Patti (2021-03-12)
      This is a presentation begins with the concept that one needs to deal with their shame - defined by Bene Brown as the exceptionally painful feeling or experience that we are flawed or unworthy of love and belonging.... - Guilt is "I did something bad.... "whereas shame is I AM Bad". The presentation then brings these theories into the workplace and demonstrates how they increase stress. Finally it introduces the notion of polyvagal theory as a way to address these concerns.
    • Diversity - How to understand yourself and others

      Sandoval, Dianna; Murphy, Leticia (2021-01-12)
      This is a presentation on diversity - defined as: understanding that each individual is unique and recognizing our individual differences. These can be along the dimensions of race, ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities, religious beliefs, political beliefs, or other ideologies. This presentation addresses the following issues: definition of diversity: difference between race & ethnicity; definition of a minority group; how to build cultural competency; increase awareness of bias & stereotypes and how to build an inclusive work environment.
    • Total Worker Health® Program Readies NIOSH for Next 50 Years

      Chosewood, L. Casey; Kirby, Emily (2022-01-18)
      As NIOSH commemorates its 50th anniversary, the NIOSH Total Worker Health® Program reflects on its past while focusing on leading the field of occupational safety and health into the future. The past and current successes of the Total Worker Health discipline are rooted in the fundamental beliefs that work and workplaces should be safe and healthy, that it is unacceptable to trade a worker’s health for wages, and that protections should extend to all workers regardless of industry, occupation, job title, or status of employment. Centered in the approach is the belief that work should be an ongoing, enriching source of well-being for workers, their families, and communities. Total Worker Health (TWH) is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. This approach prioritizes a hazard-free work environment for all workers. It also brings together all aspects of work in integrated interventions that collectively address worker safety, health, and well-being.
    • Cognitive Behavioral Therapy for Insomnia (CBTi)

      Reynolds, Maggie (2021-07-09)
      This is a presentation on insomnia and a specific treatment modality - Cognitive Behavioral Therapy used to help folks deal with this affliction. The presentation begins with the DSM-V definition of insomnia: “A predominant complaint of dissatisfaction with sleep quantity or quality” ○ At least three nights per week for at least three months ● Causes day time impair mentor stress ● Despite adequate opportunity for sleep ● Unattributable to another sleep-wake disorder, medical/mental health disorder, or to a substance. The presentation continues to define the different types of insomnia and percentages of adults in the US who complain of Insomnia ( 30-35%), the presentation then deals with misconceptions about sleep disorders and finally introduces the notion of CBTi - Replacing maladaptive sleep behaviors and thoughts with behavioral techniques and positive sleep thoughts.....
    • 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.
    • Leading Effectively by Managing Change

      VandePol, Bob; Holthaus, Jean, 1963- (2021-10)
      Many people are feeling anxiety about shedding whatever they relied upon to create safety and give them a sense of being protected. During the Pandemic this anxiety has increased for many. This presentation offered by experts in the Crisis Management field offers solid information from current surveys about the status of anxiety in the US and then offers some concrete ways of managing those fears and concerns especially from the role of someone depended on for leadership in the workplace.
    • Contrasting Epidemiology of Cholera in Bangladesh and Africa.

      Sack, David A; Debes, Amanda K; Ateudjieu, Jerome; Bwire, Godfrey; Ali, Mohammad; Ngwa, Moise Chi; Mwaba, John; Chilengi, Roma; Orach, Christopher C; Boru, Waqo; et al. (Oxford University Press, 2021-12)
    • Pathogens Associated With Linear Growth Faltering in Children With Diarrhea and Impact of Antibiotic Treatment: The Global Enteric Multicenter Study.

      Nasrin, Dilruba; Blackwelder, William C; Sommerfelt, Halvor; Wu, Yukun; Farag, Tamer H; Panchalingam, Sandra; Biswas, Kousick; Saha, Debasish; Jahangir Hossain, M; Sow, Samba O; et al. (Oxford University Press, 2021-12)
      BACKGROUND: The association between childhood diarrheal disease and linear growth faltering in developing countries is well described. However, the impact attributed to specific pathogens has not been elucidated, nor has the impact of recommended antibiotic treatment. METHODS: The Global Enteric Multicenter Study enrolled children with moderate to severe diarrhea (MSD) seeking healthcare at 7 sites in sub-Saharan Africa and South Asia. At enrollment, we collected stool samples to identify enteropathogens. Length/height was measured at enrollment and follow-up, approximately 60 days later, to calculate change in height-for-age z scores (ΔHAZ). The association of pathogens with ΔHAZ was tested using linear mixed effects regression models. RESULTS: Among 8077 MSD cases analyzed, the proportion with stunting (HAZ below -1) increased from 59% at enrollment to 65% at follow-up (P < .0001). Pathogens significantly associated with linear growth decline included Cryptosporidium (P < .001), typical enteropathogenic Escherichia coli (P = .01), and untreated Shigella (P = .009) among infants (aged 0-11 months) and enterotoxigenic E. coli encoding heat-stable toxin (P < .001) and Cryptosporidium (P = .03) among toddlers (aged 12-23 months). Shigella-infected toddlers given antibiotics had improved linear growth (P = .02). CONCLUSIONS: Linear growth faltering among children aged 0-23 months with MSD is associated with specific pathogens and can be mitigated with targeted treatment strategies, as demonstrated for Shigella. © The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America.
    • Prospects of Future Typhoid and Paratyphoid Vaccines in Endemic Countries.

      Shakya, Mila; Neuzil, Kathleen M; Pollard, Andrew J
      Low- and middle-income countries face a high burden of typhoid and paratyphoid fever due to poor water quality and inadequate sanitation. The World Health Organization (WHO) recommends the use of typhoid conjugate vaccines (TCV) in endemic settings and Gavi, the Vaccine Alliance, supports TCV introduction. There are currently 2 WHO-prequalified TCVs with Typbar TCV introduced in Pakistan, Liberia, and Zimbabwe. Countries should assess disease burden and consider introduction of TCV for programmatic use. Several paratyphoid vaccine candidates are in early stages of development. An effective bivalent vaccine would be the most efficient way to control typhoid and paratyphoid fever.
    • Typhoid Conjugate Vaccines: Advancing the Research and Public Health Agendas.

      Birkhold, Megan; Mwisongo, Aziza; Pollard, Andrew J; Neuzil, Kathleen M (Oxford University Press, 2021-12)
      The disease burden of typhoid fever remains high in endemic areas in Asia and Africa, especially in children. Recent clinical trials conducted by the Typhoid Vaccine Acceleration Consortium show typhoid conjugate vaccine (TCV) to be safe, immunogenic, and efficacious at preventing blood culture-confirmed typhoid fever in African and Asian children. Pakistan, Liberia, and Zimbabwe recently introduced TCV through campaigns and routine childhood immunizations, providing protection for this vulnerable population. It is essential to continue this momentum while simultaneously filling data gaps-including typhoid complications-to inform decision-making on TCV introduction. A multidisciplinary approach including surveillance, water, sanitation, and hygiene investments, and large-scale TCV introduction is needed to decrease the burden and mortality of typhoid fever.
    • Preoperative Factors Associated with Press Ganey Patient Satisfaction Scores after Anterior Cruciate Ligament Reconstruction.

      Perraut, Gregory T; Zhang, Tina; Weir, Tristan B; Schneider, Matheus B; Aneizi, Ali; Leong, Natalie L; Packer, Jonathan D; Meredith, Sean J; Henn, R Frank (Thieme, 2022-01-03)
      Patient satisfaction is increasingly used as a metric to evaluate the quality of healthcare services and to determine hospital and physician compensation. The aim of this study was to identify preoperative factors associated with Press Ganey Ambulatory Surgery (PGAS) satisfaction scores, and to evaluate the effect of each PGAS domain score on the total PGAS score variability in patients undergoing anterior cruciate ligament reconstruction (ACLR). A review of a Press Ganey (PG) database at a single center was performed for patients undergoing ACLR between 2015 and 2019. Ninety-nine patients completed the PGAS survey and 54 also completed preoperative demographic and patient-reported outcome measures (PROMs) for an orthopaedic registry. PGAS scores were calculated and bivariate analysis was performed. Multivariable linear regression determined the effect of each of the six PGAS domains on the total PGAS score variability. In the total cohort of 99 patients, no factors were significantly associated with the total PGAS score or any domain scores. For the 54 patients who also participated in the orthopaedic registry, none of the preoperative PROMs were significantly correlated with total PGAS score. However, having a college degree (89 vs. 95 or 97 points; p = 0.02) and continuous femoral nerve catheter (92 vs. 100 points; p = 0.04) was associated with lower personal issue domain scores, while patients with a greater number of prior surgeries had worse registration domain scores (ρ = -0.27; p = 0.049). For the entire cohort, the registration and facility domains contributed the most variability to the total PGAS score, while the physician domain contributed the least. Few preoperative factors are associated with PGAS scores, and total PGAS scores do not significantly correlate with baseline PROMs. Surgeons may have limited ability to improve their PGAS scores given most of the variability in total scores stems from systemic aspects of the patient experience.
    • Functional connectome mediates the association between sleep disturbance and mental health in preadolescence: A longitudinal mediation study.

      Yang, Fan Nils; Liu, Tina Tong; Wang, Ze (Wiley-Blackwell, 2022-01-18)
      Sleep disturbance is known to be associated with various mental disorders and often precedes the onset of mental disorders in youth. Given the increasingly acknowledged bidirectional influence between sleep disturbance and mental disorders, we aim to identify a shared neural mechanism that underlies sleep disturbance and mental disorders in preadolescents. We analyzed a dataset of 9,350 9–10 year-old children, among whom 8,845 had 1-year follow-up data, from the Adolescent Brain Cognitive Development (ABCD) study. Linear mixed-effects models, mediation analysis, and longitudinal mediation analysis were used to investigate the relationship between sleep disturbance, mental disorders, and resting-state network connectivity. Out of 186 unique connectivities, the effect of total sleep disturbance (TSP, from Sleep Disturbance Scale) and mental problems (MP, from Child Behavior Checklist) converged in the default mode network (DMN) and the dorsal attention network (DAN). Within- and between-network connectivities (DMN-DAN, DMN-DMN, DAN-DAN) mediated the relationship between baseline TSD and MP at 1-year follow-up and the relationship between baseline MP and TSD at 1-year follow-up. The pathway model in which sleep disturbance and mental problems affect each other through two anticorrelated brain networks (DMN and DAN) suggests a common neural mechanism between them. Longitudinally, a less segregated DMN and DAN is associated with negative outcomes on mental well-being and sleep disturbance a year later. These findings have important implications for the design of prevention and neurofeedback intervention for mental disorders and sleep problems. © 2022 The Authors. Human Brain Mapping published by Wiley Periodicals LLC.