Jacobs Institute of Women's Health
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For All the Primate FANS: Optimized Isolation of Nuclei from Frozen Postmortem Primate Brain for Fluorescence-Assisted Nuclei Sorting (FANS)
No full textEpigenetic alterations are cell type-specific and require methods like single cell sequencing and cell type sorting by flow cytometry. These methods often rely on the availability of fresh tissue, yet postmortem frozen tissue is typically the only material available from non-experimental subjects, including humans and other nonhuman primates (NHP). Many insights can be gained from analysis of these precious samples. To this end, we developed a protocol for isolating intact nuclei from small starting amounts of postmortem frozen chimpanzee (Pan troglodytes) cerebral cortex tissue. Isolated nuclei can be input directly into single cell epigenomics protocols like ATAC-seq or can be immunostained for enrichment of neuronal nuclei via fluorescent-activated nuclei sorting (FANS) followed by bulk epigenetic methods like methylome sequencing. We adapted and optimized this protocol based on existing human brain tissue protocols. Our protocol specifically addresses challenges presented by postmortem frozen NHP brain tissue, including high levels of myelin debris and reduced RNA integrity. We include key steps and troubleshooting guidance to improve nuclei quality and sorting outcomes, and we also discuss limitations and considerations for researchers interested in using these methods
Are There Benefits to Observation Units in the Emergency Departments: A Narrative Review
No full textVisits to Emergency Departments (ED) in the United States are increasing, creating a crowding problem, including longer length of stay in the ED (EDLOS) and worse outcomes. Many ED resort to observational units (EDOU) to help alleviate this crowding issue. This narrative review assessed the current state of literature to investigate the benefits of EDOU while reviewing the barriers to create such units. : This review utilized the Patient Intervention Control Outcome (PICO) format. The searches were performed on PubMed from its inception to 14 November 2024. The outcomes were EDLOS, hospital admission rates, and 7-day ED return rates. Any randomized trials or observational studies (either retrospective or prospective) that reported pre-EDOUs and post-EDOUs, or studies comparing patients in the EDOUs versus control were eligible. We excluded abstracts and non-original studies. : Our search identified 904 results, and we included 34 articles in this review. Four studies reported EDLOS with an average of 14-23 h. Two studies performed a comparison analysis and found a decreases in EDLOS between 23 and 28%, while two studies discovered no significant difference. Four studies reported a statistically significant reduction in hospital admission rates, with absolute reductions in rates ranging from 2.7% to 44%. Two studies found no significant difference. Both EDLOS and rates of hospital admission were more impactful when EDOU focused on a single chief complaint or narrowed criteria. Only three studies commented on 7-day ED return rate, reporting ranges from 1.9% of patients returning in 72 h, and 10.8% returning within 14 days. Additionally, they identified that 53.3% of potentially avoidable visits occurred within 48 h of discharge, and the majority of returns were related to original chief complaints. : The Observation Units for Emergency Departments offer many benefits such as potential reduction in EDLOS and hospital admissions. However, the implementation of EDOUs usually comes with high initial costs, which hinders the process. Thus, more studies with robust methodology are still needed to assess the intricacies of these benefits of the EDOUs
Interconnected pathways and emerging therapies in chronic kidney disease and heart failure: A comprehensive review
No full textChronic kidney disease (CKD) and chronic heart failure (HF) frequently coexist and, when comorbid, are associated with poorer outcomes. These two diseases have common risk factors, such as diabetes, obesity and hypertension, and common pathophysiological connected mechanisms, including inflammation, endothelial dysfunction, neurohormonal activation and fibrosis. Early diagnosis and intervention are important to slow CKD progression and reduce HF events. Shared therapeutic targets for CKD and HF include the renin-angiotensin system (RAS), sodium-glucose cotransporter 2 (SGLT2), mineralocorticoid receptor (MR) and glucagon-like peptide-1 (GLP-1) receptor. For the management of CKD, current treatment guidelines recommend the use of RAS inhibitors, SGLT2 inhibitors, the nonsteroidal MR antagonist finerenone and GLP-1 receptor agonists. Challenges in the management of patients with CKD and HF include the presence of other comorbidities, leading to polypharmacy. This review highlights gaps and opportunities for improving the management of patients with CKD and chronic HF
A Scoping Review of Pruritic Papular Eruption in People Living With HIV
No full textPruritic papular eruption (PPE) is a chronic, intensely itchy skin condition commonly seen in people living with HIV (PLH). While PPE is well documented in regions with high HIV prevalence, its clinical presentation, risk factors, and treatment strategies in the United States remain poorly characterized. Thus, this study aims to fill critical gaps in understanding PPE among PLH in the United States by investigating its epidemiology, clinical features, and risk factors. A comprehensive literature search across PubMed, Google Scholar, and Cochrane identified 8 papers documenting 11 patients with PPE. Our results showed that the most commonly affected areas included the arms (82%), chest (45%), back (45%), face (36%), neck (36%), and anal cleft (18%). Seven patients (64%) had a concurrent bacterial or fungal infection with Candida albicans (42.9%) and Treponema pallidum (42.9%). Candida lesions were most commonly seen in the oral mucosa and inguinal or anal clefts. Overgrowth of commensal organisms such as Demodex folliculorum was also noted in or around the pilosebaceous units for 28.6% of patients. The most common treatment strategies include antiretroviral therapy and adjuvant corticosteroid or ultraviolet B phototherapy which helped relieve the pruritis associated with papulonodular lesions. These findings highlight how PPE may serve as a marker for severe immunosuppression among PLH. In HIV patients who present with a rapid onset of pruritic lesions, PPE should be a key consideration in the differential diagnosis. In these patients, thorough physical examination and further diagnostic evaluation for potentially associated infections is warranted
Sustainability of the Growth of the Local Public Health Workforce During the COVID-19 Pandemic, 2019-2022
No full textTo explore whether and how the local health department (LHD) workforce shifted during the COVID-19 pandemic given the large influx of supplemental funding to public health. We used data from the National Association of County and City Health Officials National Profile of Local Health Departments, the main source of comprehensive data collected from LHDs across the United States. Total numbers of employees, total numbers of full-time equivalents (FTEs), and employee types (full time, part time, contractual, and seasonal) were used to estimate the total LHD workforce in 2022, changes in the LHD workforce from 2019 to 2022, and changes in the LHD workforce from 2019 to 2022 by employee type. In 2022, the estimated LHD workforce consisted of 182 100 employees or 163 200 FTEs. Between 2019 and 2022, there was a 19% increase in the total LHD workforce, but the size of the workforce varied according to jurisdiction size and rurality. The largest increase was among contract workers (175%), whereas the full-time workforce grew by approximately 7%, indicating that the permanent workforce was predominantly unchanged. With the surge in temporary and contract workers in 2022, there are concerns regarding the sustainability of the LHD workforce. Without continued strategic and sustained funding across jurisdiction types, the workforce may be in jeopardy. (Am J Public Health. Published online ahead of print June 12, 2025:e1-e7. https://doi.org/10.2105/AJPH.2025.308096)
EXPRESS: Domain-specific cognitive flexibility: Shift-readiness adaptations for task- and attention-switching are non-transferrable
No full textAdaptive behavior in the real world involves navigating competing goals in a constantly changing environment. Doing so requires cognitive flexibility across multiple domains, including flexibility for switching between tasks, i.e., activating the appropriate rules for stimulus-response associations, and flexibility for shifting attention between different sources of sensory inputs. Previous work in task-switching and attention-shifting has separately shown that people are capable of strategically modulating both types of flexibility based on the relevant current demands. That is, people become better at switching between tasks (e.g., digit magnitude versus parity tasks) when switches are frequently cued and better at shifting attention between different stimulus locations when shifts are frequently cued. Across five experiments in the current study, we investigated the possibility of cognitive flexibility transfer between the domains of task switching and attention shifting when the frequency of switches/shifts are orthogonally manipulated within the same context. We implemented a novel paradigm that involved concurrent cued task switching and attentional shifting. We varied either the proportion of task-switches or attention-shifts across blocks of trials, while keeping the proportion of the other constant. If flexibility adaptations in biased contexts transferred across domains, switch/shift frequency manipulations in one domain should affect flexibility across both domains. Instead, in Experiments 1-3, we found that performance costs of attentional shifts remained constant across task-switch biased contexts despite adjustments in task-switch costs; likewise, in Experiments 4-5, we found that costs of switching between tasks remained constant across blocks that varied in attention-shift frequency despite adaptations in attention-shift costs. These results suggest that probabilistic learning and adjustments of attention-shifts and task-switches to meet contextual demands occur independently
Consensus Statement on the Prevention and Management of Complications of Fully Ablative Laser Resurfacing of the Face
No full textOBJECTIVES: To achieve consensus among expert laser surgeons on standards for the prevention and management of adverse events from fully ablative laser resurfacing of the face. MATERIALS AND METHODS: Delphi study with two rounds of ratings and revisions until consensus was achieved. The draft set of statements was developed by a steering committee based on expert clinical experience. This was followed by two rounds of rating and revisions completed by an expert panel, then a virtual consensus meeting. In both rounds, respondents rated the draft statements on a 9-point Likert scale (1 = strongly disagree; 9 = strongly agree) and optionally provided comments. The consensus meeting was supplemented by the results of a systematic review of the literature (from 2000 to 2023). RESULTS: Two rounds of Delphi survey were completed by 34 participants across four countries. Represented specialties were dermatology, facial plastic surgery, plastic surgery, and oculoplastic surgery. The initial 105 statements from round 1 expanded to 112 in round 2, with 96 statements achieving consensus. These included possible adverse events (11 statements); absolute and relative contraindications to treatment (5 statements); preoperative care and antimicrobial prophylaxis precautions (16 statements); intraoperative precautions (17 statements); postoperative care (21 statements); monitoring for and management of infection (16 statements); management of pigmentation changes (6 statements); and management of scarring and incipient scarring (4 statements). CONCLUSION: An international consensus statement was developed for the prevention and management of complications associated with fully ablative laser resurfacing of the face. While expert practices vary, key factors for optimizing outcomes include careful patient selection, counseling, and meticulous pre- and postoperative care. Further research will improve our understanding of this treatment technique
SGLT2 inhibitors and Mortality in Diabetic Cancer Patients. Cardioprotective and Anticancer effects
No full textAtopic Dermatitis and Parental Guilt in the United States: Results of a Nationwide Study
No full textScoping Review of Trauma-Informed Yoga (TIY) for Survivors of Sexual, Domestic, and Interpersonal Violence and Development of the WELLNESS Mnemonic to Characterize TIY Outcomes
No full textThis scoping review provides an overview of the current evidence base for trauma-informed yoga (TIY) for survivors of sexual, domestic, and interpersonal violence to document the spectrum of study designs, population and intervention characteristics, and associated results of TIY for trauma survivors. Authors utilized the scoping review methodology outlined by Arksey and O\u27Malley (2005). Pubmed and Scopus were searched initially conducted on August 16, 2022, and updated to include any new studies on March 25, 2025. Data extracted included study design, population characteristics, intervention specifics, and results. Authors devexbvgloped an innovative mnemonic to inform discussion of results: WELLNESS: Well-being; Empathy; Longevity (durability of therapeutic effect); Lessen trauma symptoms; Nurturing (self-compassion), Ease stress, Security, and Self-awareness). The combined initial and updated literature searches yielded 4167 studies. Title and abstract screening netted 35 studies meeting review criteria. Full-text review netted 18 studies meeting criteria. Sexual, interpersonal, and domestic violence survivors who participated in TIY reported enhancement of physical and psychological function and well-being. Effects included increased sense of safety, self-compassion, personal growth, and self-regulation. Studies reported reduced depression, anxiety, negative thoughts, stress and trauma symptoms, and increased self-esteem; positive coping; improved relationships, better sleep and enhanced mindfulness; and sense of peace. TIY is beneficial to survivors of sexual, domestic, and interpersonal violence by promoting peaceful embodiment without retraumatization and enhancing affect regulation to decrease reactivity and agitation. The constellation of effects can improve the sequelae of trauma, and survivors may benefit from long-term TIY programming to ensure more robust improvement