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A Retrospective Analysis of Outcomes with Pulmonary Artery Catheter Use in Patients Diagnosed with Cardiogenic Shock
Get PDFThe primary goal of this study is to observe which timing variable of pulmonary artery catheter (PAC) insertion, or no PAC insertion is related to better in-hospital outcomes of patients with cardiogenic shock. Furthermore, additional variables like sex and health history are tested to see if they affect the relationship of PAC timing and inhospital outcomes. Data were retrospectively collected from the CSWG registry at a single center, BUMC. All variables collected were redacted and combined to form a dataset. From here I used the PAC timing and cardiogenic shock diagnosis variables to manually place patients into groups for analysis. The groups used were Prior (PAC placement before cardiogenic shock diagnosis), Early (PAC placement within 6 hours or less of cardiogenic shock diagnosis), Delay (PAC placement after 6 hours of diagnosis), None (no PAC use). 227 patients' data was collected and used for analysis. The only groups that were observed to have a significant difference in in-hospital outcomes were the Prior and Delay groups that have a significant decrease in in-hospital mortality in comparison to the Early group. The results of the analyses support that PAC timing groups Prior and Delay have less in-hospital mortality when compared to the Early group. There were no other findings to draw statistically significant conclusions from
Policy Focused Implementation Mapping to Advance Equity and Best Practice in School Asthma Services
No full textPurpose: The goal of Dissemination and Implementation (D&I) science is to reduce the gap between best practices and those services widely implemented; D&I is key to improving health outcomes and equity. Pediatric asthma services exemplify the critical need for D&I, but application to advance best practices has been limited. Despite the availability of effective treatment, the CDC estimates that 44% of children with current asthma are poorly managed with entrenched disparities in adverse outcomes. Comprehensive school asthma programs with stocked quick-relief medication are shown to be effective. However, only 2% of Texas school districts have policies to permit this intervention. Further, before 2023, Texas legislation regarding stock albuterol was at sharp variance to national recommendations. In 2023, state-wide collaboration in Texas resulted in amendments that align policy with published recommendations. Asthma 411 is a model to advance comprehensive best practices in school asthma services including stock albuterol. It is currently adopted by 350 schools in North Central Texas. Implementation mapping is a multi-step process with systematic strategies to advance each stage of D&I. Producing implementation protocols and tools is a key element of the 5th step of the process. Policy-focused implementation mapping brings these approaches to legislative initiatives to maximize public health benefits and advance equity. The purpose of this study is to initiate policy implementation mapping for the guideline-based, Texas legislation passed in 2023 focusing on protocols and tools for implementation of the Asthma 411 model. Methods: Newly passed Texas legislation (SB 294 88R) was outlined and included categories of implementation mandates along with the specific requirements within each category. Each existing Asthma 411 implementation tool was independently assessed by two researchers and matched to corresponding legislative requirements. The researchers then identified mandates and guidelines that were not matched to any existing tool. Existing Asthma 411 tools that were matched to the new requirements, were also independently reviewed by two researchers to determine whether it was in alignment with policy or required modification. Discrepancies in researcher assessment were resolved by consensus review. New tools or modifications of existing tools were then drafted to create a preliminary, full suite of tools to support Task 4 of the implementation mapping process. Results: Researchers identified eight relevant categories within the new legislation. Nine existing tools were identified that require modification to align with new legislation and associated guidelines. Five new requirements in the new policy were identified that lack a tool or protocol to support the implementation of the new policy. Draft modifications and new implementation tools have been constructed. Conclusion: The resulting set of preliminary tools are uploaded to the Asthma 411 website where they are free and available for download. Free, online, on-demand professional development modules are being constructed for the use of these tools. Evaluation is ongoing. This work exemplifies the application of policy-focused implementation mapping to produce tools that support state-level best practices to improve asthma outcomes and advance equity. The process developed may be applied to the implementation of other school health policies
Classifying Alzheimer's Disease Neuropathology Using Clinical and MRI Measurements
Get PDFBACKGROUND: Computer-aided machine learning models are being actively developed with clinically available biomarkers to diagnose Alzheimer's disease (AD) in living persons. Despite considerable work with cross-sectional in vivo data, many models lack validation against postmortem AD neuropathological data. OBJECTIVE: Train machine learning models to classify the presence or absence of autopsy-confirmed severe AD neuropathology using clinically available features. METHODS: AD neuropathological status are assessed at postmortem for participants from the National Alzheimer's Coordinating Center (NACC). Clinically available features are utilized, including demographics, Apolipoprotein E(APOE) genotype, and cortical thicknesses derived from ante-mortem MRI scans encompassing AD meta regions of interest (meta-ROI). Both logistic regression and random forest models are trained to identify linearly and nonlinearly separable features between participants with the presence (N = 91, age-at-MRI = 73.6+/-9.24, 38 women) or absence (N = 53, age-at-MRI = 68.93+/-19.69, 24 women) of severe AD neuropathology. The trained models are further validated in an external data set against in vivo amyloid biomarkers derived from PET imaging (amyloid-positive: N = 71, age-at-MRI = 74.17+/-6.37, 26 women; amyloid-negative: N = 73, age-at-MRI = 71.59+/-6.80, 41 women). RESULTS: Our models achieve a cross-validation accuracy of 84.03% in classifying the presence or absence of severe AD neuropathology, and an external-validation accuracy of 70.14% in classifying in vivo amyloid positivity status. CONCLUSIONS: Our models show that clinically accessible features, including APOE genotype and cortical thinning encompassing AD meta-ROIs, are able to classify both postmortem confirmed AD neuropathological status and in vivo amyloid status with reasonable accuracies. These results suggest the potential utility of AD meta-ROIs in determining AD neuropathological status in living persons.Research reported in this study was supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes on Aging under grant number 5P20GM109025, and the Nevada Exploratory Alzheimer's Disease Research Center (NVeADRC; P20-AG068053). Ms. Zhuang, Dr. Cordes and Dr. Nandy are additionallysupportedbyNIHgrantRF1-AG071566.Ms. Zhuang is additionally supported by the young scientist award at Cleveland Clinic Lou Ruvo Center for Brain Health (Keep Memory Alive Foundation). Dr. Cordes is additionally supported by private grants from the Peter and Angela Dal Pezzo funds, from Lynn and William Weidner, and from Stacie and Chuck Matthewson. Dr. Cummings is additionally supported by NINDS grant U01NS093334; NIA grant R01AG053798; NIA grant P30AG072959; NIA grant R35AG71476; Alzheimer's Disease Drug Discovery Foundation(ADDF);Ted and Maria Quirk Endowment; and the Joy Chambers-Grundy Endowment. Dr. Caldwell is additionally supported by NIA grants R01-AG074392, Cleveland Clinic Catalyst grant CCG0202; and The Women's Alzheimer's Movement at Cleveland Clinic
Saving Time Saves Lives: Optimizing Radio Dispatching in Out-of-Hospital Cardiac Arrests
No full textObjective Activation of emergency medical services (EMS) through radio dispatching in the United States of America is the established first component in the link of the Chain of Survival. However, little is known about how auditory dispatch alerts operationally aid in the recognition and physical response of priority dispatch communications. This research aims to determine if a modification in radio alerting procedures will elicit a reduction in chute times for first responders. Methods This study uses a retrospective pre-post design evaluating the impact on reaction times to cardiac arrest priority p-tones in a semi-urban/rural area. Data were collected by comparing a period of six months before and 10 months after the implementation of a system that replaced p-tones with digitized human speech notifications. The analysis of continuous data to determine statistical significance in response times (global positioning system (GPS)-measured) was conducted using the Student's t-test. For data normalization, Box-Cox transformations were utilized. The interpretation of control charts was used to assess process stability and evaluate the outcomes. Results Of the 16 months of continuous data and 137 case response times for priority alarms, the average response time (GPS-measured) was 29.3 seconds (M = 29.375, SD = 19.69), well below the system target time of 60 seconds. Results of the paired sample t-test show that the mean time did not differ before treatment (M = 27.86, SD = 27.213) and after treatment (M = 30.88, SD = 27.872) at the 0.05 level of significance, t(65) =.802, n = 65, p<.425. 95% CI for the mean difference: -5.384 - 12.617, r =.032. Process control charts indicated a slight reduction in the process efficiency. A secondary finding indicated that radio utilization time was reduced by five seconds due to the intervention. Conclusion Response times for EMS, including the characteristics of the priority p-tone and speech influence, are understudied. This case study introduced a methodology for designing chute time process improvement interventions. Process stability charts bring increased opportunities to measure and manage response times in EMS.Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work
Cultivating a Community of Practice to Enhance Game-Based Learning and High-Impact Practices
Get PDFThis presentation outlines the strategic development and implementation of a Community of Practice (CoP) focused on high-impact educational practices. Grounded in CoP framework, the session highlights the formation of the High-Impact Practices CoP (HIPCOP), which fosters faculty collaboration around pedagogies such as game-based learning, simulation, project-based learning, and inquiry-based learning. The presentation details the foundational elements of CoPs—domain, community, and practice—and shares a collaborative blueprint for cultivating innovation through hybrid engagement, shared deliverables, and scholarly dissemination. It serves as a model for integrating pedagogical innovation into faculty development and institutional culture
Stress Due to Inflation and Its Association with Anxiety and Depression Among Working-Age Adults in the United States
Get PDFInflation generates stress, which may lead to high rates of anxiety and depression. Given the recent surge and subsequent decline in the inflation rate in the United States, the prevalence of stress due to inflation may vary, as well as its relationship with anxiety and depression. Therefore, we investigated the prevalence of stress due to inflation and its association with anxiety and depression over time among working-age adults in the United States. We conducted a repeated cross-sectional analysis using Household Pulse Survey (HPS) data for the following weeks: Week 50 (5-17 October 2022) and Week 57 (26 April-8 May 2023). The HPS includes questions about individuals' stress levels due to price increases in the past two months. We used logistic regressions to examine the association of stress (moderate or high stress versus little or no stress) due to inflation with depression and anxiety among working-age adults controlling for several factors, including demographic factors and social determinants of health. From October 2022 to April-May 2023, the prevalence of stress due to inflation affected more than three quarters of the population (77.7% and 78.7%, respectively). In logistic regressions, we found a significant positive association of stress due to inflation with depression (adjusted odds ratio (AOR) [95% CI] = 2.22 [1.92, 2.57]) and anxiety (AOR [95% CI] = 2.50 [2.18, 2.86]). Despite a decline in the prevalence of both depression and anxiety by three percentage points over the study period, the associations between stress, due to inflation on the one hand, and anxiety and depression, on the other, persisted over time. Stress due to inflation affects more than three-quarters of Americans, and is significantly associated with depression and anxiety. Stress due to inflation is a significant and persistent public health issue.The project described was supported the by National Institute of Health (NIH)/Artificial Intelligence/Machine Learning Consortium to Advance Health Equity and Researcher Diversity Grant # 1OT2OD032581-02 (Usha Sambamoorthi) and the National Institute of General Medical Sciences, 5U54GM104942-07 (R Constance Winer). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH
Identification of Protein Networks and Biological Pathways Driving the Progression of Atherosclerosis in Human Carotid Arteries Through Mass Spectrometry-Based Proteomics
Get PDFVulnerable atherosclerotic plaques, especially hemorrhaged lesions, are the major cause of mortalities related to vascular pathologies. The early identification of vulnerable plaques helps to stratify patients at risk of developing acute vascular events. In this study, proteomics analyses of human carotid artery samples collected from patients with atheromatous plaques and complicated lesions, respectively, as well as from healthy controls were performed. The proteins isolated from the carotid artery samples were analyzed by a bottom-up shotgun approach that relied on nanoflow liquid chromatography-tandem mass spectrometry analyses (LC-MS/MS) using both data-dependent (DDA) and data-independent (DIA) acquisitions. The data obtained by high-resolution DIA analyses displayed a stronger distinction among groups compared to DDA analyses. Differentially expressed proteins were further examined using Ingenuity Pathway Analysis((R)) with focus on pathological and molecular processes driving atherosclerosis. From the more than 150 significantly regulated canonical pathways, atherosclerosis signaling and neutrophil extracellular trap signaling were verified by protein-targeted data extraction. The results of our study are expected to facilitate a better understanding of the disease progression's molecular drivers and provide inspiration for further multiomics and hypothesis-driven studies.This work was supported by the Hungarian Government grants OTKA-K-132828 (J.B.) and NKFIH FK 134605 (É.C.), the Hungarian Government grant NKFIH 149734 (J.B.), the Thematic Excellence Programme of the Hungarian Ministry for Innovation and Technology (TKP2020-NKA-04 and TKP2021-EGA-18) (J.B.), Thematic Excellence Programme of the Hungarian Ministry for Innovation and Technology (TKP2021-EGA-20) (J.T.) HUN-REN-DE Vascular Pathophysiology Research Group (J.B.), the Space Sciences Thematic Program of the University of Debrecen, and by the European Union and the European Social Fund GINOP-2.3.2-15-2016-00043 (IRONHEARTH), GINOP-2.3.2-15- 2016-00044 (PHARMPROT). É.C. and L.P. (Laszlo Prokai) acknowledge financial support from the 2022 Distinguished Guest Scientist Programme of the Hungarian Academy of Sciences. L.P. (Laszlo Prokai) also acknowledges endowment BK-0031 from the Robert A. Welch Foundation
Blood biomarkers in Down syndrome: Facilitating Alzheimer's disease detection and monitoring
Get PDFBlood-based biomarkers continue to be explored for disease detection, monitoring of progression, and therapeutic outcomes as the diagnostic determination of Alzheimer's Disease in Down Syndrome (DS-AD) remains challenging in clinical settings. This perspective highlights the current status of this effort. Overall, amyloid (A), tau (T), and neurodegeneration (AT[N]) blood-based biomarkers have been shown to increase with disease pathology for individuals with DS. Phosphorylated tau biomarkers (p-tau217, p-tau181) have been consistently shown to track disease progression for DS-AD and are likely good candidates for use in clinical settings. Biomarkers of inflammation (glial fibrillary acidic protein) also show promise; however, additional work is needed. Findings from stability work of blood-based biomarkers conducted among non-DS also support the potential longitudinal utility of biomarkers such as neurofilament light chain and p-tau181 in DS. Gaps in our knowledge are highlighted, and a potential role for sex differences in biomarker outcomes is noted, along with recommendations for determining the appropriate context of use when translating biomarkers into clinical applications. HIGHLIGHTS: An overview of blood-based biomarkers for Alzheimer's disease (AD) was provided for consideration of their utility among individuals with Down syndrome when looking toward potential clinical applications. Longitudinal stability of many blood biomarkers and improvement in detection sensitivity make blood such as plasma a viable source for exploring AD pathology. Variability in reviewed findings regarding the application of blood biomarkers highlights the importance of understanding and defining the appropriate context of use, particularly when translating them into clinical practice.Medical Research Council, Grant/Award Numbers: MR/S011277/1, MR/ S005145/1, MR/R024901/1; European Commission, Grant/Award Numbers: 1R61AG066543-01,GO-DS21-848077; Alzheimer's Society, Grant/Award Number: AS-CP-18-0020; Fondo de Investigaciones Sanitario, Carlos III Health Institute, Grant/Award Number: PI20/01473; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas; National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, and the UKDementia Research Institute at UCL, Grant/Award Number: UKDRI-1003; European Union Joint Programme—Neurodegenerative Disease Research, Grant/Award Number: JPND2021-00694;AD Strategic Fund and Alzheimer's Association, Grant/Award Numbers: ADSF-21-831376-C, ADSF-21-831381-C, ADSF-21-831377-C; Alzheimer's Drug Discovery Foundation, Grant/AwardNumber: 201809-2016862; HORIZON EUROPE Framework Programme, Grant/Award Number: 101053962; National Institute of Biomedical Imaging and Bioengineering, Grant/Award Number:P41EB015922; Horizon 2020- Research and Innovation Framework Programme from the European Union, Grant/Award Numbers: H2020-SC1-BHC-2018-2020, Marie Sklodowska-Curiegrantagreement No 860197 (MIRIADE); Departament de Salut, Generalitat de Catalunya, Grant/Award Number: SLT006/17/00119; Alzheimer Society, Grant/Award Number: AS-CP-18-0020; Foun-dation for the National Institutes of Health, Grant/Award Numbers: U19AG078109, U19AG068054, RF1AG079519, 1R61AG066543-01, 1R01AG056850-01A1, R21AG056974, R01AG061566,R01AG054073, R01AG058533; Alzheimer's Association, Grant/Award Number: 23AARFD-1022715; Swedish State Support for Clinical Research, Grant/Award Number: ALFGBG-71320; Blue-field Project; Olav Thon Foundation; Erling-Persson Family Foundation; Stiftelsen for Gamla Tjanarinnor, Grant/Award Number: F02022-0270; Swedish Research Council, Grant/Award Numbers:2022-01018, 2019-02397; Jérôme Lejeune Foundation
Temporal Trends in Single- and Multiple-Sports Team Participation Among Adolescents in the United States: Analysis Using the Youth Risk Behavior Surveillance System, 1999-2019
No full textBACKGROUND: It is unclear how levels of sport participation have changed among adolescents in the United States (US) in recent years, particularly considering evidence of increasing sport professionalization and attrition. PURPOSE: To evaluate the differences and trends in single- and multiple-team sport participation among US high school students between 1999 and 2019. STUDY DESIGN: Descriptive epidemiology study. METHODS: Using the Youth Risk Behavior Surveillance System of the US Centers for Disease Control and Prevention, a biannual representative survey of US high school students, data on self-reported sport participation (no participation, single team, multiple teams) within the previous year were evaluated. Differences in sport participation prevalence between 1999 and 2019 were assessed in sex strata by grade, race/ethnicity, and US region. Weighted trends using the National Center for Health Statistics Guidelines for Analysis of Trends and logistic regression models were employed for analyses. RESULTS: The study sample over the 20-year period (N = 149,404) was 49.8% female; the majority were in ninth grade (27.7% female, 28.7% male), were non-Hispanic White (56.1% female, 56.8% male), and resided in the Southern US (57.6% female, 57.4% male). Among girls, 27.2% (95% CI, 25.8-28.6) reported multiple sports team participation in 1999, while 21.3% (95% CI, 20.1-22.6) reported the same in 2019. Among boys, 39.5% (95% CI, 38.4-40.7) reported multiple sports team participation in 1999 versus 29.1% (95% CI, 27.7-30.6) in 2019. Analyses of trends indicated that girls experienced increasing trends in single-sport team participation (beta = 0.04, SE = 0.01, P < .001). Among boys, there were increasing trends in no sport participation (beta = 0.06, SE = 0.01, P < .001), while multiple-sport team participation decreased over the 20-year period (beta = -0.10, SE = 0.01, P < .001). Disparities in trends were observed among female and male groups by race/ethnicity, grade, and region. CONCLUSION: Sport participation over a 20-year period in the US decreased significantly for boys and increased for single-sports teams among girls. Sport specialization may be contributing some of the observed trends, though limitations in the data require additional research to confirm these hypotheses. Tailored efforts to increase sport participation among both sexes is needed.One or more of the authors has declared the following potential conflict of interest or source of funding: H.B.E. has received speaking fees from OrthoPediatrics. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto
Repetitive transcranial magnetic stimulation alleviates motor impairment in Parkinson's disease: association with peripheral inflammatory regulatory T-cells and SYT6
No full textBACKGROUND: Repetitive transcranial magnetic stimulation (rTMS) has been used to treat various neurological disorders. However, the molecular mechanism underlying the therapeutic effect of rTMS on Parkinson's disease (PD) has not been fully elucidated. Neuroinflammation like regulatory T-cells (Tregs) appears to be a key modulator of disease progression in PD. If rTMS affects the peripheral Tregs in PD remains unknown. METHODS: Here, we conducted a prospective clinical study (Chinese ClinicalTrials. gov: ChiCTR 2100051140) involving 54 PD patients who received 10-day rTMS (10 Hz) stimulation on the primary motor cortex (M1) region or sham treatment. Clinical and function assessment as well as flow cytology study were undertaken in 54 PD patients who were consecutively recruited from the department of neurology at Zhujiang hospital between September 2021 and January 2022. Subsequently, we implemented flow cytometry analysis to examine the Tregs population in spleen of MPTP-induced PD mice that received rTMS or sham treatment, along with quantitative proteomic approach reveal novel molecular targets for Parkinson's disease, and finally, the RNA interference method verifies the role of these new molecular targets in the treatment of PD. RESULTS: We demonstrated that a 10-day rTMS treatment on the M1 motor cortex significantly improved motor dysfunction in PD patients. The beneficial effects persisted for up to 40 days, and were associated with an increase in peripheral Tregs. There was a positive correlation between Tregs and motor improvements in PD cases. Similarly, a 10-day rTMS treatment on the brains of MPTP-induced PD mice significantly ameliorated motor symptoms. rTMS reversed the downregulation of circulating Tregs and tyrosine hydroxylase neurons in these mice. It also increased anti-inflammatory mediators, deactivated microglia, and decreased inflammatory cytokines. These effects were blocked by administration of a Treg inhibitor anti-CD25 antibody in MPTP-induced PD mice. Quantitative proteomic analysis identified TLR4, TH, Slc6a3 and especially Syt6 as the hub node proteins related to Tregs and rTMS therapy. Lastly, we validated the role of Treg and rTMS-related protein syt6 in MPTP mice using the virus interference method. CONCLUSIONS: Our clinical and experimental studies suggest that rTMS improves motor function by modulating the function of Tregs and suppressing toxic neuroinflammation. Hub node proteins (especially Syt6) may be potential therapeutic targets. TRIAL REGISTRATION: Chinese ClinicalTrials, ChiCTR2100051140. Registered 15 December 2021, https://www.chictr.org.cn/bin/project/edit?pid=133691.National Natural Science Foundation of China 81873777, 82071414, 82471433(QW). Initiated Foundation of Zhujiang Hospital 02020318005 (QW). Scientifc Research Foundation of Guangzhou 202,206,010,005 (QW). Science and Technology Program of Guangdong of China 2020A0505100037 (QW). Guangdong Medical Science and Technology Research Foundation Project A2020305(FX). National Medical Research Council Singapore (EKT)