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The US biomedical research workforce suffers from systemic barriers causing insufficient diversity and perpetuating inequity. To inform programming enhancing graduate program access, we implemented a formative mixed-method study to identify needed supports for program applications and graduate program success. Overall, results indicate value in added supports for understanding application needs, network development, critical thinking, time management, and reading academic/scientific literature. We find selected differences for underrepresented minority (URM) students compared to others, including in the value of psychosocial supports. This work can inform broader efforts to enhance graduate school access and provides foundation for further understanding of URM students’ experiences.
There has been an exponential rise in SSRI prescribing, between 2021 and 2022 there was a 5% increase. The majority of SSRI prescription initiation takes place in primary care. This is a national trend and mirrored internationally.
Objectives
The study was undertaken to understand barriers to deprescribing both prescribing clinicians and patients and the potential of dependence caused by continued prescribing of SSRI and SNRI. We wanted to understand deprescribing challenges and both clinical anxiety and difficulty experienced and see if there is a correlation with the Drug use screening tool (DUST) tool.
Methods
Those patients who were stable on SSRI were offered lowering of dose and deprescribing as part of routine medication reviews. During medication reviews patients were asked about willingness to embark on a deprescribing schedule. Patients were screened during medication reviews on the DUST to see if this can be used to predict difficulty with deprescribing. We designed a deprescribing difficult questionnaire to assess the difficulty experienced by clinicians during a deprescribing consultation. We were able to study the is a correlation with DUST scores and Clinician experience of difficulty and challenge in deprescribing of the SSRI and SNRI.
Results
Current alcohol drinkers and smokers were less likely to deprescribe from their antidepressants. Clinicals should do a risk assessment using the DUST screening tool checking for risk of dependence. There is an R value of 0.1586 (P-value is 0.018848) between the correlation of patients increased length time and increased DUST score causing an increased risk of dependence. The average R-score across the three practices between patient’s length of time being on medications and their DUST score is R= 0.18705 (P value of 0.01)
Conclusions
Inability to access IAPT therapies, shortened length of CBT sessions and lack of post IAPT support caused poor patient experience and contributed to reluctance to re-engage with IAPT services. Both cascade and incremental prescribing following lower doses without documentation of the limitations of medication results in unrealistic expectations generated from the prescribing. There is positive correlation between length of SSRI and SNRI prescribed, DUST scores, and Clinical challenge scores with patients’ unwillingness to be deprescribed. Patients should have a DUST score review prior to having been put onto any antidepressant as there is a potential link between increased DUST score and lower chances of willingness to deprescribe. Clinicians need to counsel patient of risk of dependence. The likelihood is these are drugs of dependence and clinicians should counsel patients of these risks and given review dates and offered deprescribing.
Patients with high fraility indices experience poor mental health due to multiple co morbidity and social isolation.
Objectives
This was a retrospective observational analysis that studied the correlation of Electronic frailty indices and GAD scores with Depression scores in a rural population.
Methods
An annual frailty assessment is offered to elderly patients and we screen routinely for anxiety and depression using the PHQ-9 score and GAD score. This was an observational study examining the correlation of the Electronic Frailty Indices (EFI) depression and anxiety scores.
Results
Of the 118 patients ranging from mild to severe frailty we found a positive correlation of the EFI with the Depression and anxiety scores. Within the data set, the correlation coefficient of EFI scores and PHQ 9 scores was found to be 0.819. Similarly within the same data set we found a correlation coefficient of EFI and GDS scores of 0.651. The higher the EFI the greater was the scale of dependency and comorbidity and this correlation was consistent across the data set with depression and anxiety. We believe physical impairment, loss of independence and social isolation cognitive decline contribute to loss of self-esteem.
Conclusions
Our study found a positive correlation between frailty severity based on EFI scores and depression and anxiety severity. Early detection in deterioration of mental health will enable supportive measures and targeted treatment strategies. Our study shows the strong correlation of EFI severity scores with worse mental health.
Apart from its role as a digestive and absorptive organ, the gastrointestinal (GI) tract is a vital immune organ that encompasses roughly 70 % of the total immune cells of the body. As such, the physical, chemical and nutrient composition of the diet influences overall GI function, effectively as an immune organ. With the improvement in feed technology, agro-industrial co-products that are high in fibre have been widely used as a feed ingredient in the diets of pigs and poultry. Arabinoxylan (AX) and mannan are the most abundant hemicellulosic polysaccharides present in cereal grain and co-product ingredients used in the livestock industry. When monogastric animals consume diets containing high amounts of AX and mannans, stimulation of GI immune cells may occur. This involves the activation of several cellular and molecular pathways of the immune system and requires a considerable amount of energy and nutrients to be expended by the animal, which may ultimately influence overall health and growth performance of animals. Therefore, a better understanding of the role of AX and mannan in immune modulation will be helpful in modulating untoward GI immune responses, thereby minimising nutrient and energy expenditure toward this effort. This review will summarise pertinent research on the role of oligosaccharides and polysaccharides containing AX and mannans in immune modulation in order to preserve gut integrity.
Early laryngeal cancer treated with definitive radiotherapy or surgery has a high cure rate. This study evaluated the patterns of treatment failure and long-term results of early laryngeal cancers treated with definitive radiotherapy.
Method
From January 2002 to December 2014, a total of 242 patients with early-stage laryngeal cancers were treated with radical radiotherapy.
Results
All patients had squamous cell carcinoma of the larynx (92 per cent male and 8 per cent female). Median follow-up was 4.5 years. The majority of patients were smokers (57.4 per cent). Local failure was seen in 12.5 per cent of stage I patients and 22.8 per cent of stage II patients. The 5-year overall survival and disease specific survival were 84 per cent and 91 per cent, respectively.
Conclusion
In summary, radiotherapy is a suitable treatment modality for patients with early-stage laryngeal cancer, with an overall locoregional control rate of 84 per cent. Patients who fail radiotherapy may still undergo salvage laryngectomy.
While SrTiO3 exhibits promising electronic transport properties, its high thermal conductivity (κ) is detrimental for its use as a thermoelectric material. Here, we investigate the influence of oxygen non-stoichiometry on κ in bulk SrTiO3 ceramics. A significant reduction in κ was achieved in oxygen deficient SrTiO3−δ, owing to the presence of oxygen vacancies that act as phonon scattering centers. Upon oxidation of SrTiO3−δ, the κ of pristine SrTiO3 was recovered, suggesting that oxygen vacancies were indeed responsible for the reduction in κ. Raman spectroscopy was used as an independent tool to confirm the reduction of oxygen vacancies in SrTiO3−δ upon oxidation.
In this investigation, a data-driven turbulence closure framework is introduced and deployed for the subgrid modelling of Kraichnan turbulence. The novelty of the proposed method lies in the fact that snapshots from high-fidelity numerical data are used to inform artificial neural networks for predicting the turbulence source term through localized grid-resolved information. In particular, our proposed methodology successfully establishes a map between inputs given by stencils of the vorticity and the streamfunction along with information from two well-known eddy-viscosity kernels. Through this we predict the subgrid vorticity forcing in a temporally and spatially dynamic fashion. Our study is both a priori and a posteriori in nature. In the former, we present an extensive hyper-parameter optimization analysis in addition to learning quantification through probability-density-function-based validation of subgrid predictions. In the latter, we analyse the performance of our framework for flow evolution in a classical decaying two-dimensional turbulence test case in the presence of errors related to temporal and spatial discretization. Statistical assessments in the form of angle-averaged kinetic energy spectra demonstrate the promise of the proposed methodology for subgrid quantity inference. In addition, it is also observed that some measure of a posteriori error must be considered during optimal model selection for greater accuracy. The results in this article thus represent a promising development in the formalization of a framework for generation of heuristic-free turbulence closures from data.
To investigate an outbreak of New Delhi metallo-β-lactamase (NDM)–producing carbapenem-resistant Enterobacteriaceae (CRE) and determine interventions to interrupt transmission.
Design, Setting, and Patients.
Epidemiologic investigation of an outbreak of NDM-producing CRE among patients at a Colorado acute care hospital.
Methods.
Case patients had NDM-producing CRE isolated from clinical or rectal surveillance cultures (SCs) collected during the period January 1, 2012, through October 20, 2012. Case patients were identified through microbiology records and 6 rounds of SCs in hospital units where they had resided. CRE isolates were tested by real-time polymerase chain reaction for blaNDM. Medical records were reviewed for epidemiologic links; relatedness of isolates was evaluated by pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). Infection control (IC) was assessed through staff interviews and direct observations.
Results.
Two patients were initially identified with NDM-producing CRE during July–August 2012. A third case patient, admitted in May, was identified through microbiology records review. SC identified 5 additional case patients. Patients had resided in 11 different units before identification. All isolates were highly related by PFGE. WGS suggested 3 clusters of CRE. Combining WGS with epidemiology identified 4 units as likely transmission sites. NDM-producing CRE positivity in certain patients was not explained by direct epidemiologic overlap, which suggests that undetected colonized patients were involved in transmission.
Conclusions.
A 4-month outbreak of NDM-producing CRE occurred at a single hospital, highlighting the risk for spread of these organisms. Combined WGS and epidemiologic data suggested transmission primarily occurred on 4 units. Timely SC, combined with targeted IC measures, were likely responsible for controlling transmission.
Relativistically hot electron–positron–ion (EPI) plasmas in the presence of relativistic intense electromagnetic (EM) radiation that are not in thermal equilibrium are studied by following a modified plasma particle distribution function. By means of a kinetic description, soliton solution is obtained for a small amplitude EM wave, whereas for large amplitude EM waves a cusp soliton solution is obtained. A general expression of positron density oscillations is obtained for long wavelength in comparison with the Debye length of electrons, and is discussed for special cases. Dispersion relations for a new type of longitudinal waves with slow damping is formulated as a consequence of resonant wave–particle interaction, and the necessary conditions for the existence of positron sound waves are obtained. Furthermore, for ultrarelativistic electrons and non-relativistic positrons, quasi positron sound waves dispersion relation in the intermediate wave range is obtained. It is shown that the modulation of amplitude of relativistic EM waves leads to instability for the rare plasma. Finally, we have obtained the relativistic kinetic nonlinear Schrödinger equation (KNLS) with local and non-local nonlinearities. The KNLS equation depicts nonlinear Landau damping rates for intense EM waves, and these damping rates are also examined.
Arbitrary amplitude and small amplitude ion-acoustic solitary waves (IASWs) have been investigated in a relativistic, collisionless, unmagnetized, and degenerate dense electron–positron–ion plasma. The arbitrary amplitude IASWs have been studied by using the Sagdeev-type pseudo-potential approach. Along with approximate solution, the exact amplitude solitary structure has also been studied numerically. The electrons and positrons are assumed to follow the corresponding Fermi distribution function and the ions are described by the hydrodynamic equations. A new dispersion relation for the ion-acoustic wave has been derived for the relativistic Thomas–Fermi plasma. An energy balance-like equation involving the Sagdeev-type pseudo-potential has been investigated and it has been shown that the concentration of plasma particles has significant effect on the permitted Mach number range of IASWs. Also, it has been pointed out that the only compressional supersonic IASWs can propagate in the relativistic Thomas–Fermi plasma. The present work would be helpful to understand the excitation of the nonlinear ion-acoustic waves in a degenerate plasma, such as in superdense white dwarfs and in the cores of massive planets.
The majority of arrhythmias presenting in infancy cardiovert readily or rapidly respond to conventional medical therapy. A small number prove highly refractory to anti-arrhythmic medications. Myocardial performance may be severely compromised by the combination of fast heart rate and negatively inotropic drugs. Some babies die. We have recently supported 2 babies with refractory arrhythmias on ECMO, both to pursue drug therapy and eventually, to support the circulation during radiofrequency ablation, with very successful results. The first patient was a 2.5 kg neonate presenting with collapse secondary to atrial ectopic tachycardia with a rate of 300/minute. Myocardial function was severely impaired. The arrhythmia was adenosine resistant and after iv amiodarone loading had no effect, esmolol infusion was started. This produced profound hypotension and the arrhythmia rapidly recommenced after DC cardioversion. In the face of such severe haemodynamic disturbance, VA ECMO was instituted. Further anti-arrhythmics were tried on-circulatory support, but the arrhythmia was incessant despite multiple DC cardioversions. Therefore radiofrequency ablation of the atrial ectopic focus was attempted on ECMO support. This was achieved uneventfully and the myocardial function rapidly improved, with decannulation 24 hours later. Unfortunately the arrhythmia recurred 2 weeks later, but was successfully treated by further ablation without ECMO. The child remains well with normal development on no medication. An 11-month-old baby presented to the GP with acute onset of lethargy and poor feeding and a heart rate of 350 bpm was noted! This was a broad complex tachycardia with independent p wave activity (confirmed with adenosine); ie ventricular tachycardia. Although initially well tolerated, the tachycardia resisted DC “cardioversion” even up to 60 J. Progressive and severe myocardial dysfunction and hypotension ensued, exacerbated by any attempts at drug therapy. The patient was therefore placed on VA ECMO. Some slowing of the ventricular rhythm was achieved with amiodarone and flecainide. The patient was then decannulated but the rapid arrhythmia recurred and ECMO was reinstituted. Electro-physiological mapping was then undertaken on ECMO support. NAVEX mapping identified a right ventricular outflow tract focus. This was resistant to conventional RF energy but was eventually successfully ablated with a “Cool-tip” catheter. Myocardial function improved rapidly, the patient was decannulated after 48 hours observation and there has been no recurrence of the arrhythmia since discharge. Although viewed as a very invasive technique, VA ECMO support here has prevented two otherwise unavoidable deaths in babies with conditions readily treated by radio-frequency techniques in older children. Not only did ECMO permit institution of aggressive drug therapy but also safely supported catheter interventions in very small patients. ECMO support should be considered early for small patients with refractory arrhythmias, before irreversible neurological compromise ensues. It could also be used electively to permit radiofrequency ablation in children whose size causes concern for safe catheter manipulation.
We have developed an empirical method to model bioresponse to the surfaces of biodegradable polymers in a combinatorial library using Artificial Neural Networks (ANN) in conjunction with molecular modeling and machine learning methodology. We validated the procedure by modeling human fibrinogen adsorption to 22 structurally distinct polymers. Subsequently, the method was used to model the more complicated phenomena of rat lung fibroblast and normal human fetal foreskin fibroblast proliferation in the presence of 24 and 44 different polymers, respectively. In each case, the root mean square (rms) percent error of the prediction was substantially less than the experimental variation, showing that the models can distinguish high and low performing polymers based on structure/property information. Using this method to screen candidate materials in terms of specific bioresponse prior to extensive experimental testing will greatly facilitate materials development for biomedical applications.
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