20966 research outputs found
Sort by
Multi-level socioeconomic modifiers of the comorbidity of post-traumatic stress and tobacco, alcohol, and cannabis use: the importance of income
No full textPURPOSE: Post-traumatic stress (PTS) symptoms are highly comorbid with substance use (i.e., alcohol, tobacco, and cannabis). Few studies have investigated potential individual-, household-, and neighborhood-level socioeconomic effect modifiers of this comorbidity in longitudinal analyses. We aim to examine interactions between this multi-level environment and PTS symptoms on future substance use behaviors.
METHODS: Data were drawn from the Advancing Understanding of RecOvery afteR traumA (AURORA) study, including 2943 individuals who presented to the emergency department (ED) within 72 h of a traumatic event. Frequency of tobacco, alcohol, cannabis use, and PTS symptoms were reported at 6 timepoints. Mixed effect Poisson models, clustered by state, were used to generate incidence rate ratios (IRRs) substance use, both cross-sectionally and prospectively. Moderation analysis of PTS and substance use, stratified by household income and area deprivation index (ADI), was conducted using mixed effect models and parallel process growth curves.
RESULTS: Significant associations were observed between PTS with tobacco, alcohol, and cannabis use frequency cross-sectionally, and for tobacco and alcohol and PTS exposure prospectively. Lower income (P \u3c 0.001) and higher deprivation (P \u3c 0.001) were associated with tobacco use, while higher income (P \u3c 0.001) and less deprivation (P = 0.01) were associated with increased alcohol use. We found modest modification by household income for alcohol and tobacco, and little evidence of modification by neighborhood ADI.
CONCLUSIONS: Household income had greater evidence of effect modification for substance use, compared to neighborhood-level ADI. Our findings demonstrate that household indicators of socioeconomic status likely modify the relationship between PTS and substance use
Sepsis Resuscitation: Caution Against Conflating Initial Fluid Resuscitation and Overall Sepsis Management
No full textThree-Dimensional Models: Biomimetic Tools That Recapitulate Breast Tissue Architecture and Microenvironment to Study Ductal Carcinoma In Situ Transition to Invasive Ductal Breast Cancer
No full textDiagnosis of ductal carcinoma in situ (DCIS) presents a challenge as we cannot yet distinguish between those lesions that remain dormant from cases that may progress to invasive ductal breast cancer (IDC) and require therapeutic intervention. Our overall interest is to develop biomimetic three-dimensional (3D) models that more accurately recapitulate the structure and characteristics of pre-invasive breast cancer in order to study the underlying mechanisms driving malignant progression. These models allow us to mimic the microenvironment to investigate many aspects of mammary cell biology, including the role of the extracellular matrix (ECM), the interaction between carcinoma-associated fibroblasts (CAFs) and epithelial cells, and the dynamics of cytoskeletal reorganization. In this review article, we outline the significance of 3D culture models as reliable pre-clinical tools that mimic the in vivo tumor microenvironment and facilitate the study of DCIS lesions as they progress to invasive breast cancer. We also discuss the role of CAFs and other stromal cells in DCIS transition as well as the clinical significance of emerging technologies like tumor-on-chip and co-culture models
Infusion-Induced Macular Holes in Pars Plana Vitrectomy: A Case Series of Six Patients
No full textPURPOSE: To describe a series of six cases in which iatrogenic macular holes were induced by the infusion fluid flow of a 25-gauge pars plana vitrectomy (PPV) system.
METHODS: This is a retrospective case series of six patients treated at Kresge Eye Institute between 2018 and 2024.
RESULTS: Iatrogenic macular holes caused by infusion fluid flow are a rare complication of PPV. In this series, five out of six patients had a history of diabetes mellitus and proliferative diabetic retinopathy. The majority of these patients were undergoing repair of tractional retinal detachments when the complication occurred. The average patient age was 47 years (range: 32-66 years). Four patients were pseudophakic, and only one had undergone prior vitrectomy. Preoperative visual acuity ranged from 20/50 to hand motion, while postoperative visual acuity ranged from 20/80 to hand motion. Two patients experienced an improvement in visual acuity postoperatively.
CONCLUSION: This case series highlights the potential risk of macular hole formation due to infusion fluid dynamics during pars plana vitrectomy. In diabetic patients with tractional retinal detachments or significant macular ischemia, we recommend positioning the infusion cannula away from the posterior pole to mitigate the risk of this complication
Identifying Barriers to Being Offered and Accepting a Telehealth Visit for Cancer Care: Unpacking the Multi-Levels of Documented Racial Disparities in Telehealth Use
No full textOBJECTIVE: To evaluate patient- and area-level factors in relation to telehealth visit use in cancer care.
STUDY SETTING AND DESIGN: We surveyed a cohort of adults with an upcoming healthcare visit related to their cancer treatment at two academic medical centers (one in central North Carolina and one in southeast Michigan) and their community affiliates. Black adults and those with a scheduled telehealth visit were purposively oversampled during recruitment. We linked respondent residential addresses to area-level measures, including broadband access. The two patient-reported outcomes of interest were (1) whether a choice in visit type (virtual or in-person) was offered and (2) scheduled visit type.
DATA SOURCES AND ANALYTIC SAMPLE: We assembled a cohort of 773 adults (response rate = 15%). After excluding nonrecall for being offered a choice, the analytic sample was 725 adults.
PRINCIPAL FINDINGS: The sample was 46% aged \u3c 65 years, 42% Black, and 67% women. Black respondents were less likely than non-Black respondents to be offered a choice, 15% versus 23%, prevalence difference (PD) and 95% CI = (-8.7%, CI: -14.4, -3.0) and if offered a choice, less likely to accept a telehealth visit (20% vs. 67%; PD = -47.0%, CI: -62.0, -32.0). Compared to men, women had a lower frequency of visit choice (16% vs. 27%; PD = -10.9%. CI: -17.4, -4.4) and accepted telehealth visits (42% vs. 63%; PD = -20.8%, CI: -36.8, -4.7). Respondents who expressed technology-related worries were less likely to accept a telehealth visit. Lower area-level technology access (e.g., broadband ownership) and higher poverty were nonsignificantly associated with less offering and less scheduling of telehealth visits.
CONCLUSIONS: Interventions to improve access to telehealth in cancer care and mitigate structural inequities (namely racism and sexism) should consider patient- and area-level barriers to being offered a choice in visit type and the ability to accept a telehealth visit
Factors associated with attrition in a diverse birth cohort study in Detroit, Michigan
No full textLong-term birth cohorts are essential for studying health and disease over the life course. The retention of participants remains a challenge in study design. Previous research works on attrition are limited in length of follow-up time and lack of racial/ethnic diversity. Using data from the Wayne County Health, Environment, Allergy, and Asthma Longitudinal Study (WHEALS; United States cohort born between 2004 and 2007, n = 1258), we first performed longitudinal latent class analyses to identify patterns of participation spanning the prenatal period and six follow-up timepoints: 1, 6, 12, and 24 months; 3-6 years; and 10-12 years. Data collection included a combination of in-person visits, home visits, home specimen kits, and staff-administered questionnaires. We examined associations between baseline factors and participation class using multinomial logistic regression modeling, and with conditional inference modeling to identify variables most strongly associated with class. We identified four participation classes: high early participation with gradual loss-to-follow-up, sporadic participation, consistently high participation, and consistently low participation. Multiple baseline characteristics were associated with participation class. The consistently high participation class was disproportionately composed of participants who were older, were of higher education, had private insurance, had suburban residence, and were with higher income. Conditional inference trees identified maternal education, insurance, and income as most strongly associated with participation class. Through latent class modeling, we show that participants who were lost to follow-up fell into distinct groupings of participation. In the future, preparatory communications with those who are at the highest risk of study discontinuation may improve long-term retention
An evaluation of lymph node harvest in sublobar resections in a statewide quality collaborative
No full textOBJECTIVE: Evaluate the effectiveness of nodal harvest in sublobar resections for peripheral non-small cell lung cancer.
METHODS: Retrospective review of prospectively collected data for patients who underwent wedge resection (WR) and segmentectomy (SG) for non-small cell lung cancer from January 2015 to March 2023 at 21 centers within a statewide quality collaborative. The primary end point was the extent of lymph node (LN) harvest defined as ≥ 10 LNs, ≥ 5 LN stations (LNSs), or 3 mediastinal LNSs and 1 hilar LNS (3/1 LNS). We also examined the LN harvest stratified by operative approach (open, video-assisted, or robot-assisted).
RESULTS: A total of 1398 patients receiving sublobar resections were reviewed: 919 (65.7%) with WR and 479 (34.3%) with SG. Only 15.6% (152) WR and 54.6% (263) SG had an adequate number of LNSs harvested. Robot-assisted thoracic surgery was associated with higher rates of harvesting ≥ 10 LNs (P \u3c .001) or harvesting ≥ 5 LNSs or 3/1 LNS (P \u3c .001) compared with video-assisted thoracoscopic surgery for WR. Compared with open procedures and video-assisted thoracic surgery, Robot-assisted thoracic surgery was associated with higher rates of harvesting ≥ 5 LNSs or 3/1 LNS for SG (P = .002 and P = .003, respectively).
CONCLUSIONS: WR and SG have low rates of adequate LN harvesting. Robot-assisted surgery was associated with improved LN harvesting rates. Given the increase interest in sublobar resections, continued focus on improving and increasing LN harvesting are needed
Unusual Presentation of Acute Appendicitis: A Case Report of de Garengeot Hernia
No full textA de Garengeot hernia (DGH) is a rare anatomic variant involving the herniation of the appendix through the femoral canal. It is an uncommon surgical entity with diagnostic challenges. We report the case of a 63-year-old woman who presented with right inguinal region pain and swelling, in which preoperative ultrasound (US) and computed tomography (CT) identified the herniated, inflamed appendix within the canal of Nuck, which was intraoperatively found to be rather a femoral hernia. This rare case illustrates the characteristic imaging features of DGH and highlights the importance of early and accurate radiologic diagnosis for surgical planning and improved patient outcomes
A Multicenter Study of an Investigational Extended Wear Insulin Infusion Set in Adults with Type 1 Diabetes
No full textBiliary Radiofrequency Ablation and Sphincterotomy Restenosis: A Unique Case of Biliary Obstruction
No full textBiliary radiofrequency ablation is an emerging adjunctive and palliative therapy for patients with ampullary and biliary tumors. Given the high mortality for these malignancies, data on long-term complications are limited. We report a unique case of sphincterotomy restenosis causing biliary obstruction in a 98-year-old woman with a history of ampullary adenocarcinoma treated with papillectomy and biliary radiofrequency ablation (RFA). Endoscopic retrograde cholangiopancreatography revealed restenosis at the sphincterotomy site, managed successfully with repeat sphincterotomy and stenting. This case highlights sphincterotomy restenosis as a potential late complication of biliary RFA and emphasizes the need for awareness of delayed biliary obstruction in post-RFA patients