Jacobs Institute of Women's Health
George Washington University: Health Sciences Research Commons (HSRC)Not a member yet
51297 research outputs found
Sort by
A Systematic Review on Preharvest Interventions Used to Control Salmonella in Poultry Rearing in the United States
No full textPreharvest interventions can play an important role in reducing Salmonella prevalence and levels entering poultry slaughter and processing establishments. Currently, there is no systematic literature review of preharvest interventions that control Salmonella in poultry in the United States (U.S.). The objective herein was to synthesize literature published on the effectiveness of preharvest interventions in U.S. poultry production. Utilizing the Methodological Expectations of Cochrane Intervention Reviews guidelines, a literature search was conducted. Experimental studies published from 1995 to 2022 assessing preharvest interventions to control Salmonella in U.S. poultry farms were included in the review if they reported prevalence or levels of Salmonella. Data were extracted from each article by two reviewers. Descriptive statistics were used to summarize key study parameters, (e.g., study design, study location, poultry type, Salmonella serotypes, type of intervention) and effectiveness of intervention. A total of 12,403 publications were identified, and 234 publications were included in the final review. The most evaluated interventions were feed/water additives (51.50%), competitive exclusion culture (10.30%), vaccination/immunization (7.88%), chemical treatments/compounds (5.45%), and probiotic culture (4.85%). Most studies focused on broiler chicken (78.20%) compared to turkey and investigated Salmonella Typhimurium (37.60%), S. Enteritidis (29.10%), and S. Heidelberg (8.48%). Overall, the effectiveness of evaluated interventions varied, though one should consider differences may be due to study design, sample sizes, and duration of interventions. This review improves our understanding of the breadth of preharvest interventions and their effectiveness against Salmonella in poultry and can be used to inform food safety policies and practices around poultry to protect public health
Comparative pregnancy rate after colorectal resection versus other surgical procedures for deep infiltrating rectal endometriosis: a systematic review and meta-analysis
No full textThe debate around colorectal surgery for endometriosis has been ongoing, but to date no meta-analysis has investigated the impact of the different surgical approaches on the pregnancy rate. The aim of this meta-analysis study was to determine in women with deep infiltrating rectal endometriosis, how does colorectal resection surgery compare to other surgical techniques (e.g., rectal shaving, disc excision) in terms of pregnancy rates. We searched PubMed, Web of Science, Cochrane library and Clinical Trials for relevant studies published from inception to December 2024. We performed a systematic review and meta-analysis of all English language full-text articles addressing colorectal resection compared with other management of deep infiltrating rectal endometriosis and presenting pregnancy outcomes. We included a study when it (i) provided data on surgical management (shaving, disc excision, and/or colorectal resection) and (ii) detailed the pregnancy outcomes in each subgroup. Four authors independently performed the initial search to evaluate the eligibility criteria. Four authors extracted the data and a fifth author checked this extraction. Of the 113 full-text articles assessed for eligibility, we included 13 in the meta-analysis. These studies represented a total of 3,248 patients. Pregnancy information was available for 2,131 patients: 1073 colorectal resection, 502 shaving, 172 disc excisions, and 384 other practices (expectant management). Colorectal resection was associated with a lower pregnancy rate compared with the other techniques (N = 2,131, odds ratio [OR] = 0.64 [95% confidence interval 0.52-0.79], p \u3c 0.001, I2 = 35%). There were similar results when comparing colorectal resection with rectal shaving (N = 952, OR = 0.51 [95% confidence interval 0.36-0.73], p \u3c 0.001, I2 = 0%), but not when comparing colorectal resection with disc excision (N = 432, OR = 0.65 [95% confidence interval 0.37-1.13], p = 0.13). Conclusions Rectal resection for endometriosis is associated with a lower pregnancy rate compared with other type of surgery, such as shaving. Trial registration: PROSPERO registration number CRD42024512328
It\u27s a Permanent Struggle to Manage It Really : Psychological Burden and Coping Strategies of Adults Living With Food Allergy
No full textFood allergy (FA) is a potentially life-threatening condition which is associated with poor quality of life and psychological distress in patients and caregivers. Although FA is often seen as a condition that affects children, increasing numbers of adults have FA, either as a condition they have grown up with or they were diagnosed as an adult. No recent research has explored the lived experiences of adults with FA and how they manage this condition. In response, this study aimed to qualitatively assess the current lived experiences of adults in the UK with FA, and how they manage this condition. Adults aged 18 years or over, with medically diagnosed FA, living in the UK were recruited through patient organisations and interviewed (n = 22). Data were analysed using template analysis. Two main themes were identified from the data. The first theme explores the influence of FA on the participants\u27 lives, in particular on their \u27psychological\u27 and \u27social\u27 well-being. The second theme unpacks the strategies participants employed to cope with and manage their FA, specifically participants\u27 deployment of \u27avoidance\u27, \u27control\u27, \u27self-monitoring\u27, and \u27adaptation\u27 to manage their FA and their anxieties around it. Clearly, FA has a profound, ongoing effect on the lives of adults. Few adults in this study were able to access any support to manage their FA and accompanying anxieties. Ways in which effective support can be made available to adults with FA must be identified and implemented
Activating antiviral immune responses potentiates immune checkpoint inhibition in glioblastoma models
No full textViral mimicry refers to the activation of innate antiviral immune responses due to the induction of endogenous retroelements (REs). Viral mimicry augments antitumor immune responses and sensitizes solid tumors to immunotherapy. Here, we found that targeting what we believe to be a novel, master epigenetic regulator, Zinc Finger Protein 638 (ZNF638), induces viral mimicry in glioblastoma (GBM) preclinical models and potentiates immune checkpoint inhibition (ICI). ZNF638 recruits the HUSH complex, which precipitates repressive H3K9me3 marks on endogenous REs. In GBM, ZNF638 is associated with marked locoregional immunosuppressive transcriptional signatures, reduced endogenous RE expression, and poor immune cell infiltration. Targeting ZNF638 decreased H3K9 trimethylation, increased REs, and activated intracellular dsRNA signaling cascades. Furthermore, ZNF638 knockdown upregulated antiviral immune programs and significantly increased PD-L1 immune checkpoint expression in diverse GBM models. Importantly, targeting ZNF638 sensitized mice to ICI in syngeneic murine orthotopic models through innate IFN signaling. This response was recapitulated in recurrent GBM (rGBM) samples with radiographic responses to checkpoint inhibition with widely increased expression of dsRNA, PD-L1, and perivascular CD8 cell infiltration, suggesting that dsRNA signaling may mediate response to immunotherapy. Finally, low ZNF638 expression was a biomarker of clinical response to ICI and improved survival in patients with rGBM and patients with melanoma. Our findings suggest that ZNF638 could serve as a target to potentiate immunotherapy in gliomas
Replicating and extending the reliability, criterion validity, and treatment sensitivity of the shortened PANSS for pediatric trials
No full textDo the shortened Positive and Negative Syndrome Scale (PANSS) (Kay et al., J Clin Psychiatry 58:538-546, 1987) versions recently developed from a National Institute of Mental Health (NIMH) pediatric dataset continue to perform well in a third independent randomized double-blind clinical trial of adolescents with schizophrenia? Secondary analysis of the double-blind, placebo-controlled aripiprazole pivotal trial data (N = 302) found that the 10-item (and 20-item) PANSS versions on which we have previously reported (Findling et al., J Am Acad Child Adolesc Psychiatry, https://doi.org/10.1016/j.jaac.2022.07.864 , 2023) continued to provide high reliability, strong convergent correlation with expected measures, and treatment effects that equaled those found in the 30-item adult PANSS. Our shortened PANSS, derived originally from the randomized non-placebo controlled NIMH Treatment of Early Onset Schizophrenia Spectrum study (TEOSS) (Sikich et al., Am J Psychiatry 165(11):1420-1431, 2008), and independently replicated in both the placebo-controlled paliperidone pivotal trial for adolescents with schizophrenia (Youngstrom et al., PsyArxiv, https://doi.org/10.31234/osf.io/zb695 , 2023), and now the placebo-controlled aripiprazole pivotal trial for adolescents with schizophrenia, has again performed as well as the full 30 item adult-patient derived PANSS. The findings suggest it is possible to reduce the PANSS interview by 2 thirds, thus reducing burden on families and pediatric patients as well as administration and training costs, while maintaining high reliability, validity, and sensitivity to treatment equal to that of the 30-item version
Evaluation of the Performance of Portable Hemoglobinometers at Measuring Hemoglobin and Detecting Anemia in a Periurban Pediatric Population in Lima, Peru
No full textAs many as one in three people worldwide have anemia, with young children at increased risk of both disease and complications. In settings without clinical laboratories, portable hemoglobinometers serve important roles in diagnosing anemia and estimating prevalence. Here, we assess the validity of two such point-of-care devices-the HemoCue Hb201 and the HemoCue Hb301-relative to the international reference standard, the cyanmethemoglobin method. In total, 428 children ages 6-60 months were recruited at health posts in Lima, Peru, and venous and capillary blood samples were collected from each participant. Venous blood was assessed with the cyanmethemoglobin method, whereas capillary blood was assessed using the Hb201 and the Hb301; 16.1% of participants were found to have anemia using the cyanmethemoglobin method. Both the Hb201 (43.7%) and the Hb301 (20.6%) overestimated this prevalence, with the former reaching statistical significance (P \u3c0.0001 and P = 0.11, respectively). Both devices also tended to underestimate hemoglobin concentration, with the Hb201 (mean difference = -0.99 g/dL; percentage error = -8.1%) being appreciably less accurate than the Hb301 (mean difference = -0.35 g/dL; percentage error = -2.7%). Areas under the curve for the Hb201 (0.92) and the Hb301 (0.93) were statistically similar (P = 0.28); however, the Hb201 incorrectly classified 29.4% of participants compared with 11.0% for the Hb301. Both devices had more false positives than false negatives. In conclusion, the Hb301 was found to be significantly more accurate than the Hb201 at measuring hemoglobin, diagnosing anemia, and estimating anemia prevalence
Pharmacoeconomic Analysis and Considerations for the Management of Kawasaki Disease in the Arab Countries-A Multinational, Multi-Institutional Project of the Kawasaki Disease Arab Initiative (Kawarabi) (A Project Methodology Paper)
No full textObjective: Kawasaki disease (KD) poses a significant risk of childhood-acquired coronary artery disease. There is a notable scarcity of comprehensive KD data from low- and middleincome Arab countries, giving rise to concerns about the underestimation of KD outcomes. To bridge these gaps, the Kawasaki disease Arab initiative (Kawarabi) was established to reinforce education, advocacy, and enhance patients\u27 health outcomes. This project\u27s primary objective is to assess the economic burden and disease-related costs affecting KD management in the Arab world, contextualized within the economic status and healthcare infrastructure of each respective country. Materials and Methods: The project employs a thorough pharmacoeconomic (PE) analysis, emphasizing societal implications, including patient expenses, hospital costs, and impacts on both the public healthcare system and private insurers. A multifaceted cost analysis methodology considers the impact of delays in acute management and potential cardiac complications, addressing hypothetical scenarios to quantify costs associated with different outcomes. Results: Unique perspectives of PEs in Arab countries and its crucial role in informing healthcare decision-making are analyzed. The project delves into the transformative role of PEs in healthcare systems. The project\u27s exploration of KD in the Arab world anticipates significant contributions to the global understanding of KD challenges. The commitment to overcoming obstacles and addressing health disparities through the transformative lens of PEs reflects a dedication to making a positive impact on KD-related public health. Conclusion: The project is emphasized by offering actionable recommendations for KD management in low- to moderate-income Arab countries, in particular, and the Middle East, in general
Clinical Practice Patterns of the Emergency Physician Workforce Before and After Attrition
No full textSTUDY OBJECTIVE: Practice patterns of the emergency physician workforce have garnered increasing attention in recent years. Our objective was to assess the clinical service volume preceding and settings practiced following emergency physician workforce attrition. METHODS: We performed a repeated cross-sectional analysis using 2013-2021 Medicare data. Emergency physician workforce attrition was defined as not billing for emergency department (ED) services in the year after having billed at least 50 services in the prior year. Outcomes included the following: (1) the quantity of ED-based clinical services in the years prior to attrition and (2) the observed non-ED practice settings billed after attrition. RESULTS: Between 2013 and 2021, 60,140 unique emergency physicians billed Medicare for more than 50 ED services in one or more years. Of these, 13,888 exhibited workforce attrition, with annual attrition rates ranging from 3.1% to 6.6% during the study period. Compared with those who remained in practice, those who exhibited attrition delivered 12.3% fewer ED services in the year immediately preceding attrition (602.2 versus 687.0 services). Notably, 27.9% of those exhibiting attrition reduced their services by more than 50% in the year before leaving, compared with 3.5% among nonattrition physicians. After leaving emergency medicine practice, 23.7% continued billing Medicare in non-ED settings, most commonly in urgent care and office-based settings. CONCLUSION: Emergency physicians reduce clinical service volume in the year preceding attrition from the workforce. After leaving the emergency medicine workforce, the minority transitioned to other clinical settings, with those remaining in the broader health care workforce commonly practicing in urgent care and office-based settings that bill Medicare