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Emma Donoghue’s Hunger Aesthetic: Famine Memory and Colonial Politics in The Wonder
No full textEmma Donoghue’s 2016 novel, The Wonder, centers on eleven-year-old Anna O’Donnell, a “fasting girl” whose apparent ability to live for months without food prompts the formation of a local committee of men who hope to prove her to be a miracle. Lib Wright, the English nurse hired to observe the girl, gradually learns that Anna had been abused by her brother and that her dangerous fast is an attempt to cleanse his soul of sin. As such, critics have rightly read this neo-gothic novel as part of an ongoing reckoning with the Irish church’s long history of abuse and as an indictment of the religious and political patriarchy responsible for silencing her story.
Set in 1859, the novel is also concerned with the historical memory of the Great Famine as a defining catastrophe of colonial history. The novel repeatedly gestures to Britain’s colonial political economy and its role in Ireland’s mass starvation and establishes a metonymic link between Anna’s self-imposed hunger and the historical trauma into which she was born. In doing so, the novel’s fictional historiography suggests links between the colonial abuses of the past and the neoliberal impositions of austerity today. At the same time, I argue, the novel represses the colonial social conditions that produce famines and thus reinscribes a colonial model of capitalist development we might expect it to challenge
Methods for a Bioengineered 3D Human Brain-like Tissue Model of Neuro-regeneration After Traumatic Brain Injury
Get PDFTraumatic brain injury (TBI) causes permanent cell death and can lead to long-term cognitive dysfunction, with no available treatments to repair the damaged brain tissue. Methods to track and understand TBI in humans are severely limited by the inaccessibility of living brain tissue, creating a need for in vitro model systems to study cellular mechanisms of degeneration and regeneration following injury. Here we describe methods to establish a 3D human brain tissue model, consisting of a silk-collagen composite scaffold seeded with human neurons, astrocytes, and microglia, to study neuro-regeneration after TBI. Step-by-step fabrication, injury, and analytical assessments of the 3D “triculture” system are described. Using this tissue model system, we demonstrate that glial cells promote regeneration of neuronal networks within the injury site over several weeks post-injury. Further, we found that regenerating networks in the 3D triculture tissues did not secrete early markers of neurodegenerative disease, but displayed signs of excitatory/inhibitory imbalance. The model system includes mechanical stability that enables physiologically relevant impact injury and long-term culture capability, as well as a modular design that allows tunability of cell contents, extracellular matrix composition, and scaffold properties. Further studies using this regenerative human in vitro platform could inform future reparative treatments to improve long-term TBI patient outcomes
Androgen hormones regulate the production on the pain-inducing inflammatory molecule IL-1β in a mouse model of inflammatory pain
Get PDFChronic pain prevalence varies between sexes with a higher incidence and duration reported in women compared to men. This disparity suggests that biological factors, such as sexual hormones, may influence pain perception and development. Among the key players in pain mechanisms, interleukin-1 beta (IL-1β), an inflammatory molecule, has been identified to activate neurons involved in pain sensation. This study explores the hypothesis that sexual hormones, particularly androgens, regulate IL-1β production in inflamed tissues, thereby influencing pain responses. To investigate this, we induced inflammatory pain in male and female mice using Complete Freund’s Adjuvant (CFA), injected into the hind paw. To assess the effect of sex hormones on the production of IL-1β and pain, we modulated the levels of sex hormones by surgical and pharmacological approaches: ovariectomy, orchidectomy, and administration of flutamide, an androgen receptor antagonist. The analysis of IL-1β levels was conducted through quantitative Polymerase Chain Reaction (QPCR). We measured mechanical pain sensitivity thresholds using the von-Frey method. Our results indicate that injection of CFA drastically increased the levels of IL-1β in the inflamed skin. Blocking IL-1β significantly reduced pain sensitivity. We found decreasing systemic androgen levels, by orchidectomy or flutamide, significantly increase IL-1β expression and pain recovery times. Overall, we found that androgens reduce the levels of IL-1β and facilitate the resolution of pain. These findings underscore the intricate relationship between sexual hormones and inflammatory mediators in the context of chronic pain, suggesting potential avenues for developing sex-specific pain management strategies that target the hormonal regulation of inflammatory pathways
Socioeconomic Disparities and Challenges in Urban Detroit: Predicting Loss to Follow-Up After Treatment for Intracranial Aneurysms
Get PDFIntracranial aneurysmal subarachnoid hemorrhages (aSAH) can cause debilitating acute and chronic symptoms, and loss-to-follow-up (LTF) is a prominent issue affecting longitudinal care. Higher rates of follow-up have been correlated with better outcomes, and this study sought to identify disparities in the urban Detroit patient population and factors that may predispose patients to not receiving post-hospitalization care.
This retrospective study identified 352 patients with ruptured aSAH from 2013-2024 treated within a metro-Detroit hospital system. LTF was defined as lack of follow-up imaging \u3e500 days post-discharge. Patient demographics and socioeconomic variables were reviewed, and Chi-square and Fisher’s tests were utilized to determine whether these variables were associated with LTF. LASSO analysis was performed to determine the impact of these variables on LTF.
287 aSAH patients were analyzed (71% female, mean age 56 years). 50.4% identified within a minority group, with a mean State Decile of 6.5 +/- 3.1 and National Percentile of 72.8 +/- 24.2. Nearly half of patients were LTF (n=137, 48%). The median distance from the hospital was \u3c25 miles. Patients LTF were more likely to be unemployed, single, have a prolonged hospital stay, mRS score \u3e2, and discharged to SNF or LTAC (all p\u3c0.05). Among predictors, payment source had the greatest influence on LTF status (β=2.219).
This study highlights the diversity of the treated aSAH population, with the average patient representing a lower-to-middle-income class demographic at state and national levels. Key predictors of LTF are multifactorial and include payment source, employment status, discharge disposition, and functional status at discharge
Complications of Breast Reconstruction: Does the Area Deprivation Index Predict Risk?
Get PDFINTRODUCTION: Despite mandated post-mastectomy reconstruction coverage since the Women’s Health and Cancer Rights Act (1998), vulnerable populations may be prone to breast reconstruction complications. The Area Deprivation Index (ADI) reflects neighborhood socioeconomic status utilizing US census data. This study investigates ADI\u27s relationship to breast reconstruction complications.METHODS: A retrospective study of immediate pre-pectoral direct-to-implant reconstruction patients at a metropolitan healthcare system from 2018-2022 was conducted. Patients were stratified by ADI: \u3c50th percentile (ADI=1-5) and ≥50th percentile (ADI=6-10). Demographics, medical history, treatment history, and postoperative outcomes were compared. Descriptive statistics identified differences between ADI groups. Minor complications were defined as incidence of hematoma, seroma, superficial wounds, full thickness necrosis, or oral antibiotic-treated cellulitis. Major complications were defined as incidence of hospital readmission or return to OR. Long-term complications were defined as incidence of capsular contracture or ≥3 revisions. Logistic regression assessed ADI’s predictive value, accounting for confounds between cohorts.RESULTS: Of 195 patients, 147 had low ADI and 48 had high ADI. Significant differences in BMI and race were found between groups. Low ADI demonstrated higher BMI (p\u3c0.01) and black patient representation (p\u3c0.01). No differences were found for any complications.CONCLUSIONS: Contradictory to the literature highlighting greater surgical complication rates in low ADI patients, our results show comparable outcomes to high ADI patients. Our multidisciplinary breast cancer program delivers high quality standardized care with early plastic surgeon consultation and patient education throughout multiple hospital systems with racial, ethnic, and socioeconomic diversity. Education, support, and access are provided equally regardless of ADI
Measures of Digital Health Literacy: A Scoping Review
Get PDFTitle: Measures of Digital Health Literacy: A Scoping Review
Authors: Leva Gorji, DO; Jessica Elderkin, BA; Eliza W. Beal, MD
Background: In the evolving field of medicine, electronic information and communication technologies have become profound tools for combating obstacles related to geographic barriers. As such, understanding and improving digital health literacy (DHL) is imperative to ensure that this form of healthcare is appropriately accessible to users. The objective of this scoping review is to gauge the tools available for assessing DHL.
Methods: A scoping review was conducted following the preferred reporting items for systematic review and meta-analyses (PRISMA) guidelines. In this review, a systematic search was conducted in PubMed and Embase. Using Covidence, a screening and synthesis of the data was performed. In total, 1111 studies were imported for screening, leaving 987 studies once duplicates were removed. 52 full-text studies were assessed for eligibility, and a total of 13 studies were included.
Results: The tools evaluated included web-based surveys, cognitive surveys, and in-person surveys. These tools were validated in variable populations, although with limitations due to the exclusive focus on English-language measures. This review underscores the importance of developing inclusive and relevant assessment tools to enhance DHL across diverse communities.
Conclusion: By addressing these gaps, we can empower individuals to effectively leverage digital health technologies, ultimately fostering greater patient engagement and reducing health disparities in an increasingly digital healthcare environment
Review of Emergency Department Utilization Before, During, and After the COVID-19 Pandemic
Get PDFBackground
Emergency departments (EDs) are the entrance into hospitals for patients with high and low acuity complaints. Since the COVID-19 pandemic began in 2020, trends have changed regarding ED utilization.
Objective
This literature review aims to understand how ED utilization has changed following the COVID-19 pandemic. Reviewing present literature can identify what is currently known about the pandemic’s effect on patient usage of EDs.
Methods
To identify relevant literature, PubMed was searched for studies published between 2018 and 2024. Search terms used to identify articles include “emergency department visit decline,” “emergency department utilization,” “urgent care,” “covid,” “coronavirus,” and “pandemic.” In total, 60 articles were reviewed. Each article’s information was screened systemically based on relevance to ED trends before, during, and after the COVID-19 pandemic.
Conclusions
In 44 articles, ED visits decreased following the COVID-19 pandemic onset in 2020 compared to pre-pandemic data, showing decline ranging from 15.1% to 66.4%. Some literature identified greater decreases specifically for visits with less acute medical complaints.1 Additionally, literature identified a rebound increase in visits after the initial decline without utilization reaching pre-pandemic levels.2
Next Steps
ED visits declined when the pandemic began in 2020 compared to pre-pandemic data on emergency visits. Some literature documents that ED utilization has not reached pre-pandemic levels, but most literature does not mention post-pandemic trends. Next steps include investigating data on emergency department visits and utilization in Detroit since the end of the COVID-19 public health emergency in May 2023.3
Citations
1. Baker O, Galbraith A, Thomas A, LeCates RF, Wharam JF. Impact of the COVID-19 pandemic on regular emergency department users. Am J Manag Care. 2024;30(5):230-236. doi:10.37765/ajmc.2024.89540
2. Kang S, Ahn TK, Seo YH, Suh YJ, Paik JH. Comparison of emergency department utilization trends between the COVID-19 pandemic and control period. Medicine (Baltimore). 2021;100(32):e26847. doi:10.1097/MD.0000000000026847
3. Silk BJ, Scobie HM, Duck WM, et al. COVID-19 Surveillance After Expiration of the Public Health Emergency Declaration - United States, May 11, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(19):523-528. Published 2023 May 12. doi:10.15585/mmwr.mm7219e
Improving Quality of Exercise Stress Echocardiogram Acquisition and Interpretation: Single center experience
Get PDFBackground: Exercise is the preferred modality of stress testing to evaluate ischemic heart disease. The sensitivity of an exercise stress echocardiogram (ESE) relies on achieving 85% of maximum predicted heart rate (MPHR) for age and on timely acquisition of images at peak stress. Guidelines recommend image acquisition within 1 minute of recovery. Our study aimed to assess the quality of ESE in our facility, both in timely image acquisition and standardized reporting.
Methods: Patients who had ESE at the John D. Dingell VA between 2023 and 2024 were reviewed. Patients who attained required workload (85% MPHR for age) were selected as the study cohort. Standard ESE protocol was followed to acquire stress echocardiogram images. Demographic and clinical data were collected, and ESE images and reports were reviewed.
Results: One hundred ESE reports were reviewed out of which 86 patients attained required workload. The group was predominantly men (90%) and average age was 53 years. Average METS achieved was 11.3. Only 19 patients (22%) had timely image acquisition at required workload and 74% (64/86 patients) had image acquisition within a minute of recovery. Majority of patients had rapid heart rate recovery. (97% at 1 minute). Duke treadmill score (DTS) was reported in 21% (18/86 patients) of the tests.
Conclusion: Our analysis reveals room for improvement to achieve guidelines recommended timely image acquisition. Additionally, inclusion of prognostic information through DTS is underutilized in our reports. These findings highlight opportunities to enhance quality that can ultimately improve patient care and outcomes
24 Hours of Postoperative Oral Antibiotics for Same-Day Discharge After Hip and Knee Arthroplasty has Low Rate of Prosthetic Joint Infection
Get PDFTitle: 24 Hours of Postoperative Oral Antibiotics for Same-Day Discharge After Hip and Knee Arthroplasty Has Low Rate of Prosthetic Joint Infection
Authors: Phillip C. McKegg, MS, Colton Clymer, BS, Hamza Raja, BS, Alexander Driessche, MSE, Gabriel Boudagh, BS, W. Trevor North, MD, Michael A. Charters, MD
Introduction:
There is no clear consensus on postoperative antibiotic protocols for same-day discharge hip and knee arthroplasties. This study evaluates prosthetic joint infection (PJI) rates in patients discharged with 24 hours of oral antibiotics after surgery.
Methods:
A retrospective review was conducted on 1,843 patients who underwent primary hip or knee arthroplasty at two ambulatory surgery centers from 2021 to 2023. Data were collected from patient charts and the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI). All received 24 hours of postoperative oral antibiotics. The primary outcome was PJI within 90 days. Chi-squared tests were used for analysis.
Results:
The cohort included 1,052 knee (57.1%) and 638 hip (34.7%) arthroplasties. Median age was 66 years, and median BMI was 31.02 kg/m². PJI occurred in 5 patients (0.3%): 3 after total hip arthroplasty (THA) and 2 after total knee arthroplasty (TKA). No significant differences in PJI rates were found based on gender, BMI, smoking status, diabetes, or procedure type (p\u3e0.05).
Conclusion:
A 24-hour course of postoperative oral antibiotics after same-day discharge THA and TKA was associated with a low PJI rate. This approach may reduce PJI risks, healthcare costs, and complications, supporting its use in postoperative care protocols
Prevalence of Glucose 6-Phosphate Dehydrogenase Deficiency among Indian Populations: A Systematic Review
Get PDFGlucose 6-Phosphate Dehydrogenase (G6PD) deficiency is the most prevalent enzyme deficiency of human erythrocytes affecting more than 500 million people globally. G6PD deficiency is the most common hemolytic X-linked genetic disease, which shows a higher prevalence rate in the malarial endemic population. This review paper aims to examine the overall frequency of G6PD deficiency in the Indian population using systemic review, with a special emphasis on the differential prevalence rate across the populations. PubMed, Google Scholar, and Science Direct databases were searched to examine the scientific studies focusing on the prevalence of G6PD deficiency amongst the Indian populations. A total of 52 studies were selected after following several inclusion-exclusion criteria, which comprised a total of 66,470 participants. It is observed that the G6PD deficiency is higher among males than females, which is expected as this enzymopathy is caused by inherited mutations of the X-linked gene G6PD. Moreover, the disorder is considerably greater among the populations that prefer consanguineal and endogamous marriages, like Parsi, Muslim, and tribal populations as compared to the non-tribal and caste populations. Hence, culturally based marriage practices may help to explain differences in the frequency of this hemolytic genetic disorder among Indian populations