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Un-binding the Umwelt: The Differential Contributions of the Five Classical Senses can be Understood Through Hindu Tantra
No full textInformation from our senses, memories and thoughts is bound together into a unified whole that constitutes our experience of our world, our Umwelt. However, our ability to investigate our Umwelt through standard Western-derived neuroscience is limited, because of the third-person approach that undergirds the field. Achieving greater coherence in our understanding requires the addition of an approach which is fundamentally integrative. The most comprehensive first-person approach to the nervous system can be found in the introspective traditions of Tantric Hinduism. In this review, we explore the hierarchical ordering of the senses in Hinduism (from most gross to the most subtle, the latter being closer to consciousness), and how this may be linked to sensorimotor coupling in the parietal cortex. We demonstrate how this ordering parallels the developmental history of the sensory cortices over the course of vertebrate evolution. The synergy between biosemiotics and neurophenomenology is made clear, as the idea of a Great Chain of Semiosis can be very helpful in understanding the reasons behind the emergence of this sensory hierarchy. The structures of the Subtle body described in Hindu Tantra should be seen as semiotic nodes used by the conscious agent in interacting with the world around it. We propose that metaphor ties together the various sensory mappings of the body at the cognitive level. Integrating insights from Hindu Tantra will help modern science better investigate questions of agency, meaning and semiosis in organisms
Reporting standards in randomized controlled trials involving neuro-oncology caregivers: A systematic review report from the RANO-Cares working group
No full textBACKGROUND: Family caregivers in neuro-oncology (eg, spouse, family member, friend to a patient) have high unmet support needs, yet intervention trials and effective support options are scarce. The Response Assessment in Neuro-Oncology (RANO)-Cares working group investigated the methodological quality of neuro-oncology caregiver outcomes reporting in randomized controlled trials (RCTs).
METHODS: A systematic review was performed to evaluate to what extent RCTs assessing outcomes of caregivers of adult primary brain tumor patients adhere to minimum reporting standards. A 33-item checklist (23 applicable to secondary analysis reports) based on the International Society for Quality of Life Research (ISOQOL) criteria for patient-reported outcome reporting was used. Risk of bias was assessed per RCT.
RESULTS: A systematic review was performed to evaluate to what extent RCTs assessing outcomes of caregivers of adult primary brain tumor patients adhere to minimum reporting standards. A 33-item checklist (23 applicable to secondary analysis reports) based on the International Society for Quality of Life Research (ISOQOL) criteria for patient-reported outcome reporting was used. Risk of bias was assessed per RCT.
CONCLUSIONS: Whilst there are opportunities to enhance reporting standards, RCTs that include neuro-oncology caregiver outcomes generally adhere to high-quality reporting standards and have low risk of bias, indicating good potential to impact clinical practice
Postoperative Management Following Endoscopic Skull Base Reconstruction: A Multidisciplinary Cross-Sectional Survey
No full textBACKGROUND: There is limited consensus on management protocols and practice patterns following endoscopic skull base surgery (ESBS).
METHODS: An online-based survey focusing on ESBS practice patterns was anonymously distributed to the American Rhinologic Society, North American Skull Base Society, and American Head and Neck Society Skull Base Section membership.
RESULTS: A total of 130 surgeons (81.5% in academic positions) completed the survey. Regarding reconstructive materials, 36.9% always used autologous as opposed to synthetic materials, with variation in specific materials used. Lumbar drain was never used by 22.3% of respondents, while high BMI or suspected intracranial hypertension (43.1%) and high-flow leak or large dural defects (50.0%) were indications for lumbar drain usage. There was significant variation in types of nasal packing, type, and duration of postoperative activity restrictions, antibiotic use, and debridement protocols.
CONCLUSION: Postoperative management following endoscopic skull base reconstruction is highly complex, with a wide variety of practice patterns.
LEVEL OF EVIDENCE: N/A
Creation and evaluation of a gender diversity focused cultural competency training for phlebotomists: Study protocol for a randomized controlled trial
No full textBACKGROUND: Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual (LGBTQIA+) patients face unique challenges when navigating the healthcare system. In laboratory medicine, LGBTQIA + patients may experience bias and stigma when interacting with phlebotomists and laboratory professionals leading to substandard care and safety concerns. Education and job-specific training can help improve cultural competency on the part of lab staff. Our group developed a web-based LGBTQIA + cultural competency training tailored to the educational needs of phlebotomists with the goal of improving interactions with gender-diverse patients.
METHODS: We propose a randomized control group study to compare the effectiveness of a gender-cultural competency training to improve phlebotomist knowledge, attitudes, and care delivery skills related to gender-diverse patients. The development and design of the education followed consensus recommendations. In order to appeal to our target audience, the educational material is accessible, engaging, and not- time- or labor-intensive. To distribute the training to several sites over a limited time, we will utilize an online educational platform as opposed to a face-to-face curriculum.
CONCLUSIONS: The principal investigators anticipate that providing adequate training to phlebotomists will statistically improve their overall cultural competency and lead to an improved ability to provide affirming, safe and competent care to patients within the gender-expansive community. If successful, we anticipate that both national and international organizations can easily adapt this curriculum for their use
Disparities in SARS-CoV-2 Infection Among Arab Americans Living in Southeast Michigan
No full textCOVID-19 has disproportionately affected racial and ethnic minority groups in the USA, nevertheless, there is little research regarding how it impacted the Arab American (ArA) population. In this retrospective study, we investigated potential disparities between ArA and Caucasian (CA) groups during the first 2 years of the pandemic. The study included 110,896 adult patients who were tested for SARS-CoV-2 at eight emergency departments (EDs) within a large health system in Southeast Michigan between March 1, 2020, and July 31, 2022. Univariate analysis revealed that ArA had greater odds (OR 2.16, 95% CI 2.03-2.29) of testing positive compared to CA and significantly lower odds (OR 0.69, 95% CI 0.62-0.77) of subsequent hospitalization compared to CA. There were no significant differences in hospital mortality, 30-day ED revisit, or 30-day rehospitalization. After adjusting for age, gender, health insurance type, and a variety of co-morbidities, ArA had significantly higher odds of infection (adjusted OR 2.10, 95% CI 1.97-2.25) compared to CA, while there were no differences in other outcomes. Our study showed significantly higher risk of COVID infections in ArA and necessitates further research to understand factors contributing to this finding and measures to decrease the infection risk in this population in future pandemics
Traditional Versus Dual Lumen Microcatheter-Assisted Parallel Wiring in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the PROGRESS-CTO Registry
No full textBACKGROUND: The effectiveness and safety of traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) has received limited study.
AIMS: To compare traditional versus dual lumen microcatheter (DLMC)-assisted parallel wiring.
METHODS: We compared the clinical and angiographic characteristics and outcomes of traditional versus DLMC-assisted parallel wiring after failed antegrade wiring (AW) in a large, multicenter CTO PCI registry.
RESULTS: Among 1353 CTO PCIs with failed AW with a single wire, traditional parallel wiring (n = 1081) or DLMC-assisted parallel wiring (n = 272) were utilized at the operator\u27s discretion. The baseline characteristics of patients were similar in both groups except for higher prevalence of diabetes mellitus, and lower prevalence of hypertension, prior heart failure, prior MI and cerebrovascular disease in DLMC patients. Lesions in the DLMC group were more likely to have proximal cap ambiguity, side branch at the proximal cap, blunt/no stump, moderate/severe calcification, and had higher J-CTO score (2.6 ± 1.0 vs. 2.1 ± 1.3, p \u3c 0.001). Technical (87.1% vs. 74.3%, p \u3c 0.001) and procedural (83.8% vs. 75.5%, p = 0.001) success and the incidence of in-hospital major cardiac adverse events (MACE) (4.8% vs. 2.0%, p = 0.020) were higher in the DLMC group. In propensity score matching analysis, DLMC-assisted wiring was associated with higher technical success (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.33-3.54, p = 0.002) and no significant difference in MACE (OR 2.00, 95% CI 0.89-4.50, p = 0.093).
CONCLUSIONS: In lesions that could not be crossed with AW, DLMC-assisted parallel wiring was associated with a higher likelihood of technical success, without an increased risk of MACE, compared with traditional parallel wiring
Outcomes of Intracoronary Brachytherapy for In-Stent Restenosis
No full textBecause of limited alternative options, intracoronary brachytherapy (ICBT) continues to be used for treating in-stent restenosis (ISR). We examined the indications, characteristics, and outcomes of ICBT in consecutive patients who underwent ICBT for ISR between January 2014 and December 2023 at a tertiary care center. During the study period 343 patients underwent ICBT of 502 lesions. The median patient age was 67 [60, 74] years, 73.4% of the patients were men, 77.3% had prior myocardial infarction, and 49.4% had prior coronary artery bypass graft surgery. The most common target vessel was the right coronary artery (38.7%) and 7.37% of lesions were in bypass grafts (33 saphenous vein grafts, 4 arterial grafts). A diffuse ISR pattern was found in 76.2% of lesions. Among the study lesions, 58.0% had 2 stent layers and 20.6% had 3 or more stent layers. Technical success was achieved in 96.1% of lesions. Follow-up was available for all patients with a mean follow-up of 701.5 days. The 3-year incidence of target lesion failure (TLF), target vessel myocardial infarction, and major adverse cardiac events were 36.4%, 17.2%, and 45.6%, respectively. In multivariable analysis, higher brachytherapy radiation dose was associated with a lower risk for TLF (aHR per 10 Gy: 0.73; 95% CI 0.54-0.93; p = 0.048). Repeat ICBT procedures had a higher incidence of TLF over 3 years compared with lesions treated with ICBT for the first time (log-rank test: p = 0.008). In conclusion, the 3-year incidence of TLF after ICBT is 36.4% and was lower with higher radiation dose and higher in lesions retreated with ICBT
A Retrospective Cohort Study of Oral Antimicrobial Therapy Offers in Hospitalized People Who Inject Drugs Who Elect for Self-directed Discharge
No full textOBJECTIVES: To evaluate infection management in people who inject drugs (PWID) who elect for self-directed discharge (SDD) and to identify characteristics associated with an oral antimicrobial therapy offer (OATO).
METHODS: This was a retrospective cohort of hospitalized adult PWID with an injection drug use (IDU)-related infection who elected for SDD between January 1, 2014, to January 31, 2024, at a five-hospital health system in southeast Michigan. Patients were excluded if they were hospitalized for \u3c 24 hours or if antimicrobial treatment was completed before SDD. The primary outcome was the proportion of patients with an OATO at or before SDD. Secondary outcomes at 30 days included retreatment, infection-related readmission, and all-cause mortality.
RESULTS: One hundred fifty patients were included; 55 (37%) received an OATO, 95 (63%) did not receive an offer. Patient outcomes were not different between the OATO and no offer groups: infection retreatment 19 (34%) versus 32 (34%); infection-related readmission 14 (25%) versus 31 (33%); and all-cause mortality 1 (2%) versus 3 (3%). In multivariable logistic regression, variables independently associated with OATO included prescribing/continuing medications for opioid use disorder (MOUD) (adjusted odds ratio [aOR], 2.8; 95% CI: 1.36-5.92), infection source control (aOR, 2.3; 95% CI: 1.10-4.84), and early-career clinician care (aOR, 2.8; 95% CI: 1.01-7.89).
CONCLUSIONS: Most hospitalized PWID with IDU-related infections with SDD did not receive an OATO. Early career clinicians more commonly offered oral antimicrobials in PWID with less complicated infection types. Standardizing OATO in PWID at risk for SDD should be considered as a future direction to improve health outcomes
Adherence to Annual Lung Cancer Screening and Rates of Cancer Diagnosis
No full textIMPORTANCE: Adherence to annual lung cancer screening (LCS) is a proposed quality metric for LCS programs, but data linking annual adherence to lung cancer outcomes are lacking.
OBJECTIVE: To investigate annual LCS adherence rates across 2 subsequent LCS rounds among adults undergoing baseline LCS and examine the association of adherence with lung cancer diagnosis rates.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adults aged 55 to 75 years who formerly or currently smoked and underwent baseline LCS between January 1, 2015, and December 31, 2018, across 5 US health care systems in the Population-Based Research to Optimize the Screening Process-Lung Consortium. Participants with missing Lung Computed Tomography Screening Reporting & Data System scores or a lung cancer diagnosis prior to LCS initiation were excluded. Data were analyzed from October 2023 to October 2024.
EXPOSURES: For negative baseline screening results, T1 and T2 screening adherence was defined as chest computed tomography (CT) between 10 and 18 months and 22 and 30 months after baseline, respectively. For positive baseline screening results, T1 and T2 adherence was defined as chest CT between 11 and 21 months and 28 and 36 months after baseline, respectively.
MAIN OUTCOMES AND MEASURES: The main outcomes were annual T1 and T2 LCS adherence rates and associations between T1 and T2 screening adherence; annual incident lung cancer diagnoses in rounds T0 (0-12 months after baseline), T1 (\u3e12 to 24 months after baseline), and T2 (\u3e24 to 36 months after baseline); and cancer stage distribution.
RESULTS: A total of 10 170 individuals received baseline LCS (median age, 65 years [IQR, 60-69 years]; 5415 [53.2%] male). During round T1, 6141 of 10 033 eligible patients (61.2% [95% CI, 60.2%-62.2%]) were adherent, and during round T2, 5028 of 9966 eligible patients (50.5% [95% CI, 49.5%-51.4%]) were adherent. T1 adherence was significantly associated with T2 adherence (adjusted relative risk, 2.40; 95% CI, 2.06-2.79). Across 36 months of follow-up, 279 patients (2.7%; 95% CI, 2.4%-3.1%) were diagnosed with lung cancer. Incident lung cancer diagnosis rates were 1.3% (95% CI, 1.1%-1.6%), 0.7% (95% CI, 0.5%-0.8%), and 0.8% (95% CI, 0.6%-0.9%) during rounds T0, T1, and T2, respectively. Lung cancer diagnosis rates were higher among individuals who were LCS adherent vs nonadherent during both rounds T1 (59 of 6141 [1.0%; 95% CI, 0.7%-1.2%] vs 8 of 3892 [0.2%; 95% CI, 0.1%-0.4%]; P \u3c .001) and T2 (63 of 5028 [1.3%; 95% CI, 1.0%-1.6%] vs 12 of 4938 [0.2%; 95% CI, 0.1%-0.4%]; P \u3c .001). A greater proportion of early-stage lung cancers were diagnosed among individuals adherent to screening at T2 compared with those who were not (46 of 63 [73.0%] vs 3 of 12 [25.0%]; P = .006).
CONCLUSIONS AND RELEVANCE: In this multicenter cohort study of adults undergoing LCS, screening adherence was associated with increased overall and early-stage lung cancer detection rates; however, adherence decreased annually after baseline screening, suggesting that it is an important LCS quality metric