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Altered metabolomics and inflammatory transcriptomics in human bone marrow adipocytes after acute high calorie diet and acute fasting
No full textExpansion of bone marrow (BM) adipocytes has been linked to nutritional pressures, suggesting that BM is a dynamic compartment that responds to fluctuations in systemic nutritional availability to regulate osteogenesis and hematopoiesis. Here, we investigated BM metabolism in response to acute overnutrition (high calorie diet; HCD) and calorie deprivation (fasting). Participants underwent a 10-day HCD followed by a two-week interval of an ad libitum diet and then underwent 10 days of fasting. BM adipocytes and sera were collected before and after each dietary intervention for each participant. Using comprehensive and integrated analyses, we characterized nutritional influences on BM adiposity. BM adipocytes after HCD showed an upregulation of FOXP3, the transcription factor that controls the development of Tregs, which are critical in reducing inflammatory immune responses. After fasting, BM adipocytes had an upregulation of inflammatory genes (CP, CFH, VCAN, and IGFBP3). Proteomic analysis after HCD showed that BM serum had an upregulation of proteins related to an inflammatory/complement pathway. After fasting, in the BM serum, there was a significant downregulation of inflammatory/complement pathway proteins. Despite both interventions causing BM adipose tissue expansion, the mechanism for adipogenesis appears to be dependent on nutrient availability. After HCD, lipid-mediated signaling and lipid storage, and lipid droplet biogenesis were significantly downregulated. In contrast, after fasting, lipid-mediated signaling and lipid storage, and lipid droplet biogenesis were significantly upregulated. Overall, our results demonstrate key differences in inflammatory response and lipid metabolism between HCD and fasting, despite a nearly identical BM adipose phenotype. Further analyses are needed to understand the effects nutritional pressures have on BM adipogenesis and immune responses
Opportunities to improve the medical education experience in an interprofessional educational Setting: An application of concept mapping
No full textThe Interprofessional Partnership to Advance Care and Education (iPACE™) model was developed and piloted on an Internal Medicine (IM) unit at Maine Medical Center to promote interprofessional care and education. Although there were many benefits of this care model, residents had multiple concerns that limited model acceptance. Concept Mapping (CM) was identified to further explore, understand, and address these concerns
Mouth Matters: Impact of Therapeutic Communication on Inpatient Oral Hygiene Practices in Medical-Surgical Units
Full text linkPICOT Question: In adults over 18 years of age on a medical-surgical floor(P), how can therapeutic communication strategies be implemented to encourage oral hygiene practices(I), compare to providing the resources without therapeutic communication(C), in maintenance of daily oral hygiene practices(O), during length of hospital stay(T).https://knowledgeconnection.mainehealth.org/nurseresidency/1119/thumbnail.jp
March 12th, 2025: Heat Vulnerability in Older Adults: Exposure, Sensitivity, and Adaptive Capacity to Extreme Heat
No full texthttps://knowledgeconnection.mainehealth.org/medicine_gr/1037/thumbnail.jp
Midodrine initiation criteria, dose titration, and adverse effects when administered to treat shock: A systematic review and semi-quantitative analysis
No full textOBJECTIVE: Systematically examine the literature describing midodrine to treat shock and to summarize current administration and dosing strategies. DATA SOURCES: Structured literature search conducted in MEDLINE (PubMed) from inception through May 10, 2023. STUDY SELECTION AND DATA EXTRACTION: Abstracts and full texts were assessed for inclusion by two blinded, independent reviewers. English-language publications describing use of midodrine in adult patients with shock were included. Data were extracted by two blinded, independent abstractors using a standardized extraction tool. Quality assessments were completed by paired reviewers using JBI methodology. DATA SYNTHESIS: Fifteen of 698 (2%) screened manuscripts were included with 1,714 patients with a variety of shock types. Seven studies (47%) were retrospective, two (13%) prospective observational, and six (40%) randomized controlled studies. Midodrine was initiated to facilitate intravenous vasopressor (IVP) weaning in most (11, 73%) studies; only two (13%) reported IVP weaning protocol use. Starting doses were 10 mg every 8 hours (4, 27%) or three times a day (3, 20%), 20 mg every 8 hours (2, 13%); six studies (40%) did not report initial midodrine dosing. A midodrine titration protocol was reported in 6 (40%) studies. Thirteen (87%) studies evaluated for bradycardia, identified in 6 (46%) studies among 204 patients; only one (0.5%) patient required midodrine discontinuation. Three (20%) studies reported on hypertension with an incidence of 7-11%. Four (27%) studies assessed for ischemia; 5/1128 (0.4%) patients experienced mesenteric ischemia requiring midodrine discontinuation. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: This review explores the pragmatic details involved in initiating, titrating, and weaning midodrine for the bedside clinician and identifies rates of adverse events and complications. CONCLUSIONS: Published literature describing midodrine use for shock is heterogeneous and comprised primarily of low or very low quality data. Future controlled trials addressing the shortcomings identified in this systematic review are warranted
Social Media and Development of Sexual and Gender Identity in Adolescents
No full textSexual and gender development are key components of adolescence. As social media becomes increasingly ingrained in youth culture, it is essential to understand its impact on these developmental pathways. Social media provides a novel avenue for adolescents to explore identity, sexuality, and intimacy-as well as newfound autonomy and risk taking. Adolescents typically use social media for age-appropriate interactions and many find mental health benefits, alongside potential risks to mental and physical health. Clinicians should use a nonjudgmental tone to inquire about adolescent online behaviors and to counsel patients on safe and developmentally appropriate identity and relationship development
Tropheryma whipplei infection presenting as indolent endophthalmitis
No full textTropheryma whipplei (T. whipplei) infection can be difficult to diagnose due to its variable clinical manifestations and the limitations of standard diagnostic tests. This case describes a 78-year-old male with blurry vision and floaters in his right eye five months after cataract surgery, along with new onset weight loss and arthralgias. Ophthalmologic examination revealed inflammation and posterior vitritis, and vitreous biopsy identified T. whipplei via broad-range bacterial PCR, despite negative vitreous cultures and unremarkable flow cytometry. Gastrointestinal endoscopic and cerebrospinal fluid studies revealed no pathological or molecular evidence of the disease, complicating the diagnosis. Treatment with intravenous ceftriaxone followed by oral trimethoprim-sulfamethoxazole for 12 months resulted in resolution of symptoms and inflammation, with normalization of laboratory markers. This case underscores the diagnostic utility of broad-range bacterial PCR in atypical infections and highlights Whipple infection as a differential diagnosis in ocular presentations. Comprehensive interdisciplinary evaluation was critical for effective management
Implementing an Educational Model for Cardiac Arrest Patients During Interfacility Transfers
No full textBackground Out-of-hospital cardiac arrest (OHCA) is a significant health concern in the United States, particularly in rural areas where patient care often depends on interfacility transfers (IFTs) to tertiary medical centers. In Maine, OHCA outcomes vary widely across regions, with no standardized education or protocols for the IFT of these patients. A key step toward improving care for this population is providing emergency medical service (EMS) personnel with education on essential aspects of post-return of spontaneous circulation (ROSC) management. To address this need, we developed a pilot virtual curriculum focused on post-ROSC care during IFT. The curriculum was designed to be virtual due to restrictions on in-person didactics at the time of implementation during the COVID-19 pandemic. This study aims to evaluate the feasibility of implementing a virtual curriculum that can be easily distributed. Additionally, we seek to analyze pre- and post-survey data from EMS personnel to assess changes in confidence, anxiety, and knowledge related to post-ROSC care. Methods Two local EMS departments, which handle the majority of IFTs for our institution, were invited to participate in the virtual educational model. The model consisted of a 27-minute recorded session divided into sections and distributed via an online platform in collaboration with Maine EMS. To assess the impact of the curriculum, EMS personnel completed electronic surveys administered through REDCap. A pre-survey was conducted before the curriculum, followed by a post-survey after its completion. The survey included questions measured on a 5-point Likert scale, covering confidence in resuscitation (five questions), anxiety during resuscitation (six questions), knowledge about post-ROSC care (eight questions), and attitudes toward the curriculum (three questions). Data analysis was performed using the Wilcoxon paired signed rank test to evaluate changes across these variables. Results A total of 18 EMS personnel participated in the curriculum (18/24; 75%), with all 18 completing the pre-survey and 10 completing the post-survey. Among those who completed both surveys, 70% agreed or strongly agreed that the IFT curriculum would improve patient care. Regarding knowledge of post-ROSC care, participants showed a mean improvement of +2.125 correct answers across the eight knowledge-based questions, with an average post-survey score of 6/8 (75%). However, there were no significant changes in confidence, skill, or anxiety levels, as indicated by a p-value of \u3e0.9. Conclusions This pilot curriculum demonstrated the feasibility of delivering and completing a virtual educational model for EMS personnel on a topic not currently covered by Maine\u27s state protocols or existing educational programs. Pre-post survey results indicated some improvement in participants; knowledge of post-ROSC care, and 70% believed the curriculum would enhance patient care. Future efforts are underway to integrate this content as a permanent component of local EMS education, given the significant role of ROSC management during IFTs
Summary of: An Asset-Based Examination of Contextual Factors Influencing Nutrition Security: The Case of Rural Northern New England
Full text linkNumerous assets are available to support rural nutrition security in northern New England.https://knowledgeconnection.mainehealth.org/nnectr/1009/thumbnail.jp