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Malaria prevention in the age of climate change: A community survey in rural Senegal.
No full textBACKGROUND: Malaria results in over 600,000 deaths per year, with 95 percent of all cases occurring in sub-Saharan Africa. Insecticide treated mosquito nets have long been proven to be the most effective prevention method to protect at-risk people from malaria. Temperature increases may now be changing sleeping habits and how people use available mosquito nets. Based on observations of increasing outdoor sleeping and fragility of the mosquito nets, this study evaluated a rural west African population to determine barriers to mosquito net use, including net fragility, heat and outdoor sleeping.
METHODS: This study used a social ecological framework used by the Peace Corps to determine this community\u27s barriers to malaria prevention. We practiced community-based participatory research by developing and implementing a survey in rural southeast Senegal. Local village health workers received special training to implement this survey. Observations of the mosquito nets and sleeping spaces were performed by surveyors. 164 households in 20 villages were surveyed from October to November of 2012.
RESULTS: There was a 100% response rate, with 164 of the 164 selected households surveyed, representing 21% of this local population. For the 1806 family members, respondents assessed a total need of 1565 nets, implying that each individual in this area needs 0.86 nets (95% CI: 0.77-0.95). Survey responses gave rich, informative responses about mosquito net use. For example: \u27If it\u27s in the room set up properly under the mattress then it will be fine. But if it\u27s outside with the beds that don\u27t have mattresses, then it will deteriorate quickly.\u27 The main reasons for not using an available net were heat and fragility of the nets. This population had very positive attitudes regarding mosquito nets and appreciated the work of local malaria educators.
CONCLUSIONS: In a rural Senegalese population with a high malaria burden, our survey indicated a need for 0.86 insecticide treated nets per person. This is 54% higher than the current WHO recommendation of 0.56 ITNs per person. Our findings suggest that there are not enough nets because routine village conditions lead to considerable net damage, and because the heat leads people to sleep outdoors, where they likely do not have mosquito nets. With global warming, we suspect this population will spend even more time sleeping outside, aggravating the current insufficiency. Further research should investigate optimal interventions to address this challenge, including nets designed for outside use and for higher durability
Sense of Purpose and Perceived Person-Environment Fit\u27s Effect on Burnout in Vascular Surgery Residents.
No full textBACKGROUND: Vascular surgery residents face a high degree of burnout, despite the identification of modifiable risk factors. Business organizations have used the psychosocial work environment including workplace fit and sense of purpose to assess employee satisfaction and productivity. We sought to evaluate the effect of these factors on burnout in vascular surgery trainees.
METHODS: An electronic questionnaire was sent to all US vascular surgery fellowship and residency program directors to distribute to their trainees. This survey included 15 questions compiled from the Danish Psychosocial Work Environment Questionnaire, Meaning of Life Questionnaire, and Oldenburg Burnout Inventory to assess the psychosocial work environment, sense of purpose, burnout, as well as demographic information. Univariate analysis was performed to identify factors associated with sense of purpose, workplace fit, and burnout.
RESULTS: 83/319 (26%) trainees at 54 accredited programs completed the questionnaire (ages ranging from 21-50, 26 females (38.2%), 39 males (57.4%)). A total of 43.4% were married, 20.9% had children, and 88.2% had a mentor in vascular surgery. Higher psychosocial work environment inversely correlated to burnout (P \u3c 0.0001) and presence of purpose directly correlated with burnout (P \u3c 0.0001). Male trainees were found to have higher burnout scores (P = 0.04) and less trust between colleagues (P = 0.03). Furthermore, those who has a mentor in vascular surgery had a significant relationship to the presence of purpose (P = 0.007) and higher burnout scores (P = 0.007).
CONCLUSION: This study shows the utility of examining burnout through a psychosocial lens. Further analysis into these relationships could yield actionable interventions that tackle root causes of burnout
Increased occurrence of migraine aura and susceptibility to spreading depolarizations at altitude.
No full textHeadache is a common consequence of ascent to high altitudes, and acute mountain sickness shares many features with migraine. Evidence also suggests that the prevalence of migraine is increased in people living at both high and moderate elevations. Here we identify an increased occurrence of migraine aura with increasing elevation. Our findings are supported by multiple lines of clinical evidence including a chart review characterizing the phenotype, a systematic prospective cohort comparison between moderate and low elevation, cross-sectional data from a multicenter headache clinic registry, and a nationwide electronic medical record-based dataset. In data from mice housed in altitude chambers, we show that susceptibility to spreading depolarization is increased with simulated elevation, providing a candidate mechanism for the altitude phenotype. The increased susceptibility to aura and SD with elevation may provide a unique opportunity to develop targeted strategies for mitigation relevant to the nearly 1 billion people worldwide living at higher elevations worldwide
The Paradox of Tolerance as a Shield to Demonstrate Intolerance.
No full textKarl Popper first articulated the paradox of tolerance in The Open Society and Its Enemies in 1945. Essentially, the concept emerged from the notion that if we extend tolerance to those who are intolerant, we risk enabling intolerance as a norm, undermining the concept of tolerance. Unfortunately, history shows the paradox has been alive and well for centuries. Meanwhile, using the argument as a shield to normalize someone\u27s intolerance is unacceptable. A paradox within the paradox. This is particularly seen when someone\u27s ideology is threatened
Glycosylated Hemoglobin Levels in the Third Trimester for Predicting Adverse Pregnancy and Neonatal Outcomes in Women with Pre-Gestational Diabetes: A Multi-Center Retrospective Cohort Study in South Korea.
No full textReducing Hospital-Acquired Infections: Implementing Dual Registered Nurse Verification for Foley Catheter and Central Line Indications
No full textAction Collaborative on Traumatic Brain Injury Care: Adapted Clinical Practice Guideline.
No full textOutpatient follow-up care for traumatic brain injury (TBI) is inconsistent. The Action Collaborative on TBI Care, convened under the auspices of the National Academies of Sciences, Engineering, and Medicine, aimed to standardize management with a clinical practice guideline. The guideline is intended for community-dwelling adults with TBI who are able to care for themselves at hospital discharge or who did not require acute hospital care. Guideline topics were selected and prioritized with input from individuals with lived experience and clinicians. Existing evidence-based clinical practice guidelines (k = 18) were identified from systematic literature reviews. Recommendations for each priority topic were extracted from existing guidelines and synthesized using the ADAPTE process. Strength of evidence ratings were assigned based on the American Academy of Family Physician\u27s adaptation of GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) through consensus voting. A draft guideline underwent external review by 20 health professional and brain injury organizations. The Action Collaborative on TBI Care guideline provides recommendations for 11 priority topics: (1) confirm the diagnosis; (2) determine whether emergency department evaluation is required; (3) request neuroimaging and neuropsychological assessment when indicated; (4) screen for social determinants of health; (5) provide guidance on return to usual activities; (6) educate the patient and family; (7) assess for risk of persistent symptoms; (8) prioritize which symptoms to target first; (9) initiate treatment for posttraumatic headache; (10) screen and initiate treatment for mental health disorders; and (11) decide if and when to refer to specialty care
Professional Identity in Nursing: A Cross-Sectional Study of Acute Care Nurses
No full textAim: Our study aimed to identify nurses’ perception of professional identity, in themselves and their peers. Our primary objective was to describe the sample when stratified by high self or peer rating of professional identity. The secondary objective was to describe relationships between participant characteristics and ratings for each domain characterizing professional identity. Our final aim was to describe relationships between participant characteristics and ratings for each domain characterizing the Professional Identity in Nursing Scale (PINS)-self and PINS-environment/peer.
Background: PIN is defined as how an individual feels about themselves in the way that they think, act, and feel like in a nurse in their workplace and in relationship with others around them.
Design: The study was a cross-sectional design, inviting eligible nurses to complete a one-time survey using the PINS.
Materials and Methods: Data were collected from June to September 2022 with 334 nurse participants. Nurses were recruited from participating hospitals within a single, large, nonprofit, Catholic health system in the United States.
Results: Nurses more frequently rated self (PINS-self score) at an average “proficient” or higher level as opposed to peer (PINS-environment/peer score). In the sample, older generational cohort correlated with higher scores in all four self but not environment/peer domains. The highest average scores were observed in the “values and ethics” domain.
Conclusions: Our findings suggest professional identity develops over time. Nurses should continue developing innovative ways to strengthen the professional identity of themselves and their peers in the workplace
Updated Overall Survival Analysis From the Phase II PHAROS Study of Encorafenib Plus Binimetinib in Patients With BRAF V600E-Mutant Metastatic Non-Small Cell Lung Cancer.
No full textThe phase II PHAROS study previously showed that encorafenib plus binimetinib has antitumor activity in patients with BRAF V600E-mutant metastatic non-small cell lung cancer (mNSCLC). In PHAROS, 98 patients (59 treatment-naïve; 39 previously treated) received encorafenib 450 mg once daily and binimetinib 45 mg twice daily. We report updated results from data cutoff of March 14, 2025. The median duration of treatment with both encorafenib and binimetinib was 16.3 months in treatment-naïve and 5.5 months in previously treated patients. After median follow-up for overall survival (OS) of 52.3 months in treatment-naïve patients, mOS was 47.6 months (95% CI, 31.3 to not estimable); 4-year OS probability was 49% (95% CI, 35 to 62). After median follow-up for OS of 48.2 months in previously treated patients, mOS was 22.7 months (95% CI, 14.1 to 32.6); 4-year OS probability was 31% (95% CI, 16 to 47). In treatment-naïve and previously treated groups, 58% and 26% received ≥1 subsequent systemic anticancer treatment, respectively. Safety profile remained consistent with that in previous analyses. Although comparisons across trials should be done cautiously, to our knowledge, encorafenib plus binimetinib was associated with the longest mOS reported to date with targeted treatment in patients with treatment-naïve BRAF V600E-mutant mNSCLC