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The LvL UP trial: Protocol for a sequential, multiple assignment, randomised controlled trial to assess the effectiveness of a blended mobile lifestyle intervention
No full textBACKGROUND: Blended mobile health (mHealth) interventions - combining self-guided and human support components - could play a major role in preventing non-communicable diseases (NCDs) and common mental disorders (CMDs). This protocol describes a sequential, multiple assignment, randomised trial aimed at (i) evaluating the effectiveness and cost-effectiveness of LvL UP, an mHealth lifestyle intervention for the prevention of NCDs and CMDs, and (ii) establishing the optimal blended approach in LvL UP that balances effective personalised lifestyle support with scalability. METHODS: LvL UP is a 6-month mHealth holistic intervention targeting physical activity, diet, and emotional regulation. In this trial, young and middle-aged Singaporean adults at risk of developing NCDs or CMDs will be randomly allocated to one of two initial conditions (\u27LvL UP\u27 or \u27comparison\u27). After 4 weeks, participants categorised as non-responders from the LvL UP group will be re-randomised into second-stage conditions: (i) continuing with the initial intervention (LvL UP) or (ii) additional motivational interviewing (MI) support sessions by trained health coaches (LvL UP + adaptive MI). The primary outcome is mental well-being. Secondary outcomes include anthropometric measurements, resting blood pressure, blood metabolic profile, health status, and health behaviours (physical activity, diet). Outcomes will be measured at baseline, 6 months (post-intervention), and 12 months (follow-up). DISCUSSION: In addition to evaluating the effectiveness of LvL UP, the proposed study design will contribute to increasing evidence on how to introduce human support in mHealth interventions to maximise their effectiveness while remaining scalable. TRIAL REGISTRATION: The LvL UP Pilot trial was prospectively registered with ClinicalTrials.gov (NCT06360029)
Third Proceedings of The North American Airway Collaborative (NoAAC): Consensus Statement on Trial Design for Airway Stenosis
No full textIMPORTANCE: Airway stenosis is a rare but debilitating disorder that significantly degrades the quality of life in affected patients. Treatments are primarily surgical, and disease management lacks established medical therapies. The North American Airway Collaborative held its third symposium at The Johns Hopkins Hospital in Baltimore, Maryland, on April 15, 2024, focused on strategies to advance the care of these patients. The proceedings summarize the discussion of trial design in airway stenosis and the resulting North American Airway Collaborative consensus regarding clinical end points for rigorous study of novel therapies. OBSERVATIONS: The lectures and panels centered on the translation of a growing body of preclinical data into therapeutic targets. Additionally, detailed discussion explored design of clinical trials to evaluate safety and efficacy of novel therapeutics. The need for a consensus regarding clinically meaningful end points in airway stenosis was identified to facilitate the comparison of outcomes across institutions and future multi-institutional trials. CONCLUSIONS AND RELEVANCE: The group achieved consensus regarding change in peak expiratory flow as the primary clinical end point in airway stenosis. Additional clinical measures, such as disease recurrence (identified as time to recurrent intervention), anatomical characterization of subglottic scar via axial computed tomography imaging, and patient-reported outcome measures (Clinical COPD Questionnaire [CCQ], Voice Handicap Index-10 [VHI-10], Eating Assessment Tool-10 [EAT-10], and 12-Item Short-Form Health Survey, version 2 [SF-12]) were identified as essential secondary outcomes
Treatment Strategies for Intermediate Spinal Instability Neoplastic Score Patients: A Systematic Review
No full textBACKGROUND: The Spinal Instability Neoplastic Score (SINS) is used in determining instability in patients with spinal metastases. Intermediate scores of 7 to 12 suggest possible instability, but there are no clear guidelines to address patients with these scores. METHODS: We searched in PubMed, EMBASE, and Cochrane databases for studies that included patient demographics, tumor histology, surgical or radiotherapy management, and outcomes of patients with intermediate SINS. We reported mean differences and odds ratios (ORs) to assess differences between patients managed surgically versus with radiotherapy alone. RESULTS: Thirteen articles, totaling 1822 patients with intermediate SINS were analyzed. In 5 studies (38.4%), the management decision was based on a tumor board review. There was no significant difference between surgical management versus radiotherapy (P = 0.24). When dichotomized into SINS 7-9 and 10-12, the OR for surgical management in the 10-12 group compared to the 7-9 group was 6.88 (95% confidence interval [CI] 2.31-20.5, P = 0.0005). More renal cell carcinomas were managed surgically instead of with radiotherapy alone than other tumor types (OR = 1.87, 95% CI = 1.14-3.05, P = 0.01). There was no statistical difference in overall complications between the 2 treatment groups (OR = 1.12, 95% CI = 0.49-2.54, P = 0.79). Vertebral fracture rates after any radiotherapy type ranged between 20% and 66%. The need for a surgical procedure, including stabilization, vertebroplasty, or kyphoplasty after radiotherapy ranged from 5% to 34.2%. CONCLUSIONS: Complication rates after surgery versus radiotherapy in the intermediate SINS category are similar, but the complication types differ. Patients in the 10-12 SINS subgroup, due to larger lytic area and higher probability of vertebral body fracture, could benefit from stabilization before radiotherapy
Nurses communication competencies in social media: A bibliometric review
No full textOBJECTIVE: To analyse the characteristics of articles published on the competencies, abilities, knowledge and education that nurses should have to be able to communicate, inform, disseminate and/or be an informative source in mass media and social media. DESIGN: This bibliometric study involved a comprehensive search of two databases, PubMed and Scopus. The search terms included \u27nursing\u27, \u27communication\u27, and \u27mass media\u27, along with their synonyms. Article selection was performed through screening titles and abstracts, with any uncertainties resolved through discussions among the researchers. DATA SOURCES: The data were sourced from PubMed and Scopus, selected for their extensive coverage of academic literature related to nursing and communication. METHODS: A total of 1,290 articles were initially identified. After screening, 463 articles were analysed. The study employed bibliometric analysis to evaluate publication trends, authorship patterns, and thematic focus. Key metrics such as annual publication growth rate, co-authorship, and thematic prevalence were assessed. RESULTS AND DISCUSSION: The analysis revealed that the articles were published from 1,971 onwards, with an annual production growth rate of 6.83%. The total number of authors was 1,645, with an average co-authorship of 3 to 4 researchers per article. The most frequently discussed themes included Social Media, COVID-19, and Nurses. Notable authors included Booth R. (5 articles), Borycki E. (4 articles), and Jackson D. (4 articles). The most prominent journal was Nurse Education Today (20 articles), with the highest publication output from the United States (695 articles), followed by Australia (436 articles). Leading institutions included King Saud University (47 articles) and the University of Tripoli (37 articles). CONCLUSION: This bibliometric review provides valuable insights for researchers, educators, and managers interested in the evolving role of nursing in traditional and social media. It highlights key researchers, influential journals, significant authors, and prominent countries in this field, offering a foundational understanding for further research and development in nursing communication competencies
Insulin clearance at randomisation and in response to treatment in youth with type 2 diabetes: a secondary analysis of the TODAY randomised clinical trial
No full textAIMS/HYPOTHESIS: Insulin resistance and compensatory hyperinsulinaemia are core features leading to beta cell failure in youth-onset type 2 diabetes. Insulin clearance (IC) is also a key regulator of insulin concentrations, but few data exist on IC in youth-onset type 2 diabetes. In a secondary analysis of our Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) randomised clinical trial, we investigated potential sex-, race-, ethnicity- and treatment-related differences in IC in youth-onset type 2 diabetes and aimed to identify metabolic phenotypes associated with IC at baseline and in response to metformin, metformin plus a lifestyle intervention, and metformin plus rosiglitazone. METHODS: A total of 640 youth aged 10-18 years with type 2 diabetes underwent fasting blood tests, anthropometric measurements, dual-energy x-ray absorptiometry to estimate subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) mass, and OGTTs longitudinally over 5 years. IC was calculated from the fasting C-peptide:insulin ratio (fasting IC) and 2 h OGTT C-peptide incremental AUC (iAUC):insulin iAUC ratio (2 h IC). Linear mixed models were used to assess covariate effects on the mean of IC over repeated time points. RESULTS: Baseline fasting IC (×10 nmol/pmol) was significantly lower in female participants than male participants (median [IQR] 0.72 [0.57-0.93] vs 0.79 [0.63-1.00], respectively; p=0.04) and in non-Hispanic Black participants than Hispanic and non-Hispanic White participants (median [IQR] 0.64 [0.51-0.81] vs 0.78 [0.64-1.00] vs 0.84 [0.68-1.01], respectively; p\u3c0.0001). Similar results were observed for 2 h IC. Lower IC most strongly correlated with higher weight over time (% change [95% CI] in IC per 5 kg increase: fasting IC -1.52 [-2.05, -0.99]; 2 h IC -3.46 [-4.05, -2.86]). Lower IC also correlated with other markers of adiposity (higher BMI and SAT mass), and markers of insulin sensitivity (higher waist:height ratio, VAT mass, VAT:SAT mass ratio, triacylglycerol concentrations, triacylglycerol:HDL-cholesterol ratio, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] concentrations, and systolic and diastolic BP, and lower HDL-cholesterol and total and high molecular weight adiponectin concentrations) over time. Beta cell function as determined from OGTTs, not insulin sensitivity or IC, was predictive of persistently elevated blood glucose levels. IC was higher with metformin+rosiglitazone than metformin alone (p=0.03 for fasting IC; p=0.02 for 2 h IC) and metformin+lifestyle (2 h IC, p=0.005), but not after adjusting for adiponectin (p value not significant for all). CONCLUSIONS/INTERPRETATION: In youth with type 2 diabetes, low IC is correlated with female sex, non-Hispanic Black race and ethnicity, and markers of adiposity and insulin resistance, but not with beta cell function. Along with insulin sensitivity and adiponectin, IC increased in response to rosiglitazone treatment. These findings suggest that, in youth-onset type 2 diabetes, low IC is a compensatory response to changes in insulin sensitivity and/or adiponectin concentrations and is not a mediator of beta cell function. TRIAL REGISTRATION: ClinicalTrials.gov NCT00081328 DATA AVAILABILITY: Data from the TODAY study (V4; https://doi.org/10.58020/2w6w-pv88 ) reported here are available on request from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repository (NIDDK-CR) Resources for Research ( https://repository.niddk.nih.gov/ )
CPR Block
No full textMedium: Digital
I wanted to create some original illustrations of the science, physiology, and anatomy we were learning during our CPR section. These illustrations are definitely not anatomically correct as I typically did not use any references.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1028/thumbnail.jp
HMS Victory
No full textMedium: Photograph.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1006/thumbnail.jp
Stoney View
No full textMedium: Photograph.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1009/thumbnail.jp
slow burn
No full textMedium: Colored pencils.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1013/thumbnail.jp
untitled
No full textMedium: Photograph.https://hsrc.himmelfarb.gwu.edu/artshow_gallery_2025/1015/thumbnail.jp