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Cortical bone mechanics technology signal quality maintains robustness across a range of biometric profiles
No full textCurrent methods of diagnosing osteoporosis, such as DXA, have limitations in predicting fracture risk. Cortical bone mechanics technology (CBMT) offers a novel approach by using a three-point bend test with multifrequency vibration analysis to directly measure ulnar bending stiffness and calculate flexural rigidity, a mechanical property highly predictive of whole-bone strength under bending conditions. Cortical bone mechanics technology targets the diaphyseal ulna, a site composed primarily of cortical bone, enhancing its specificity for cortical bone quality. In this study of 388 postmenopausal women, we developed and validated a 20-point signal quality indicator (SQI) scoring system to quantify CBMT signal quality and evaluated its relationship to biometric characteristics. The SQI was developed through expert assessment of representative frequency response function (vibration data) trials and refined over 17 iterations. The final system achieved excellent classification performance (AUC = 0.974; sensitivity, specificity, and accuracy all >97%). A total of 22 740 trials were collected across 758 total arm tests, sampling 10 ulnar sites per arm under three vibration amplitudes. Two expert analysts evaluated signal features associated with high signal quality. The resulting SQI is fully automated and provides real-time feedback. All correlations between SQI scores and biometric attributes were weak or very weak (|ρ| < 0.30). The correlations with body weight (ρ = -0.11), BMI (ρ = -0.12), ulnar BMD (ρ = -0.17), CBMT-derived flexural rigidity (ρ = -0.28), and grip strength (ρ = 0.17) were statistically significant (p < .05) but remained small in magnitude. SQI scores were modestly lower in individuals with higher BMI or flexural rigidity (~2 to 3 points), but values remained in the acceptable-to-good range. This study introduces a robust, automated CBMT signal quality metric and demonstrates that its performance remains stable across a broad range of biometric profiles, supporting its application in both clinical and research settings
Origin, evolution, and success of pbla, the gonococcal beta-lactamase plasmid, and implications for public health
No full textNeisseria gonorrhoeae is a leading cause of sexually transmitted infection (STI) and a priority AMR pathogen. Two narrow host range plasmids, pbla and pConj, have contributed to ending penicillin and tetracycline therapy, respectively, and undermine current prevention strategies including doxycycline post-exposure prophylaxis (Doxy-PEP). Here, we investigated the origin and evolution of the beta-lactamase plasmid, pbla. We demonstrate that pbla was likely acquired by the gonococcus from Haemophilus ducreyi, and describe the subsequent evolutionary pathways taken by the three major pbla variants. We show that the ability of pConj to spread pbla promotes their co-occurrence in the gonococcal population and the spread of pbla. Changes that mitigate fitness costs of pbla and the emergence of TEM beta-lactamases that confer increased resistance have contributed to the success of pbla. In particular, TEM-135, which has arisen in certain pbla variants, increases resistance to beta-lactams and only requires one amino acid change to become an extended spectrum beta-lactamase (ESBL). The evolution of pbla underscores the threat of plasmid-mediated resistance to current therapeutic and preventive strategies against gonococcal infection. Given the close relationship between pbla and pConj, widespread use of Doxy-PEP is likely to promote spread of both plasmids, strains which carry pConj and are resistant against third generation cephalosporins, and the emergence of plasmid-mediated ESBL in the gonococcus, with significant public health consequences
Human naïve B cells show evidence of anergy and clonal redemption following vaccination
No full textIn an era of predicted emerging pandemics, the production of effective vaccines may require an in-depth understanding of the biology of human naive B (BN) cells. Here we provide evidence that the majority of BN cells expressed CD73, an ecto-5'-nucleotidase often associated with immune cell suppression, and demonstrated features of anergy, including an IgMlowIgD+ surface phenotype, reduced calcium flux in response to IgM crosslinking, and increased PTEN expression. Analysis of antibody sequences encoded by the inherently autoreactive VH4-34 heavy chain produced by plasmablasts seven days following influenza vaccination showed that in younger but not in older individuals, anergic BN cells provided a reservoir of B cells capable of responding to vaccination by somatic mutation, resulting in diversification and loss of autoreactivity. These results suggest that effective human vaccines may require the ability to awaken or 'redeem' anergic BN cells that can be repurposed to participate in pathogen-specific responses
Stringent Abortion Laws and the Physician Struggle
No full textRestrictive abortion laws undermine evidence-based maternal care, forcing health care professionals to act against scientific standards and creating ethical dilemmas that compromise maternal health
Tirzepatide on ingestive behavior in adults with overweight or obesity: a randomized 6-week phase 1 trial
No full textTirzepatide induces weight reduction but the underlying mechanisms are unknown. This 6-week phase 1 study investigated early effects of tirzepatide on energy intake. Male and female adults without diabetes (n = 114) and a body mass index from 27 to 50 kg per m2 were randomized 1:1:1 to blinded once-weekly tirzepatide or placebo, or open-label once-daily liraglutide. The primary outcome was change from baseline to week 3 in energy intake during an ad libitum lunch with tirzepatide versus placebo. Secondary outcomes assessed self-reported ingestive behavior and blood-oxygenation-level-dependent functional magnetic resonance imaging with food photos. Tirzepatide reduced energy intake versus placebo at week 3 (estimated treatment difference -524.6 kcal (95% confidence interval -648.1 to -401.0), P < 0.0001). With regard to secondary outcomes versus placebo, tirzepatide decreased overall appetite, food cravings, tendency to overeat, perceived hunger and reactivity to foods in the environment but did not impact volitional restriction of dietary intake. At week 3 versus placebo, tirzepatide did not statistically significantly impact blood-oxygenation-level-dependent activation to highly palatable food photos (aggregated category of high-fat, high-sugar foods and high-fat, high-carbohydrate foods) but decreased activation to high-fat, high-sugar food photos in the medial frontal and cingulate gyri, orbitofrontal cortex and hippocampus. Our results suggest tirzepatide reduces food intake, potentially by impacting ingestive behavior
In Vitro Accuracy of the E-PEX Electronic Apex Locator Compared to the Root ZX II in the Presence of Various Irrigation Solutions
No full textIUIIntroduction: Determining the end point of instrumentation and obturation is one the most important aspects of a well-done non-surgical root canal treatment (NSRCT). This reference point determines the working length, and is commonly calculated with the aid of an electronic apex locator (EAL), which accurately identifies the apical foramen which in turn determines the working length. Throughout endodontic procedures, clinicians utilize a range of irrigants to chemically debride and disinfect the root canal system (RCS), often operating an EAL concurrently in the presence of these solutions. These solutions may affect the accuracy of EALs. Recently a new EAL that uses multiple frequencies has been introduced that may offer benefits over existing EAL’s.
Objectives: This study aims to evaluate the accuracy of a novel EAL, the E-PEX, in comparison to the well-established Root ZX II, in determining the position of the apical foramen under the influence of various endodontic irrigants.
Materials and Methods: Fifty-six extracted single-rooted teeth had the distance from a coronal reference point to the apical foramen measured. The visual length (VL) was determined using a dental operating microscope (DOM) by placing a #10 K-file in the canal and visualizing where it exits the tooth under magnification. Teeth were then mounted in alginate as a conducting medium, placing various irrigation solutions in the canal during measurements: saline (0.9% sodium chloride), 3% NaOCl, 17% EDTA, and 2% chlorhexidine gluconate. The measurements for the apical foramen were made using the Root ZX II and E-PEX. The length measurements of both EALs were compared for accuracy against the VL measurement.
Outcome: The E-PEX and the Root ZX II were both be able to accurately determine the canal length. The different irrigation solutions used did not affect the accuracy of both EALs when allowing for a 0.5mm margin of error. This study provides further support for the use of the E-PEX electronic apex locator in the clinical setting
Isolated renal sarcoidosis and concurrent secondary membranous nephropathy: a case report
No full textBackground: Sarcoidosis is a chronic inflammatory disease characterized by abnormal T-cell responses to unknown antigens. It is a multisystem disorder, affecting the lungs and intrathoracic lymph nodes in over 90% of cases. Isolated renal sarcoidosis, a rare presentation, is confined to the kidneys without systemic involvement.
Case presentation: A 46-year-old African American female was evaluated for persistently abnormal serum creatinine and pyuria. The only abnormality on her noninvasive workup was an elevated angiotensin converting enzyme level for which she was evaluated previously and she was not found to have any manifestations of sarcoidosis. We performed a kidney biopsy that showed findings of renal sarcoidosis and concomitant membranous nephropathy. Patient was treated with high-dose corticosteroids with stabilization of kidney function and resolution of sterile pyuria.
Conclusion: Our case highlights that an elevated angiotensin converting enzyme level can predate the development of an overt renal sarcoidosis. It also shows that findings of a secondary membranous nephropathy can sometimes be seen in the absence of overt proteinuria in sarcoidosis involving the kidneys
Feeding Community, Fighting Insecurity: The Role of the Common Market in Muncie's Food Desert
No full textThis study examines food insecurity of low-income neighborhoods in Muncie, Indiana, focusing on the role of the Common Market in addressing this issue. Food security levels were assessed using a USDA-adapted survey distributed to 30 participants at a community holiday event at the Common Market, with data collected through paper and digital formats. Results reveal that 63.3% experience low or very low food security, with families disproportionately affected. The Common Market’s sliding-scale pricing, acceptance of Supplemental Nutrition Assistance Program (SNAP) benefits, and community-driven initiatives, including a community garden, provide essential support to mitigate food insecurity. Findings emphasize the need for continued investment in community-based solutions and policy changes to address food insecurity's economic and social dimensions
2023 Indiana Registered Nurse (Clinical Nurse Specialists Only) Workforce Snapshot
No full textThis report provides an overview of Indiana’s Clinical Nurse Specialist (CNS) workforce as of the 2023 renewal period. It presents data on actively practicing CNSs, including their primary practice settings, specialties, populations served, and educational backgrounds. It also includes geographic distribution and service area information, offering a valuable resource for healthcare workforce planning, policy development, and system evaluation
Recruitment of People with Cognitive Impairment and Caregivers for a Randomized Clinical Trial
No full textRecruiting older people with cognitive impairment (PwCI) and their caregivers (CG) for research studies is an ongoing challenge, which was magnified by the onset of COVID-19. This study describes the unique recruitment of PwCI-CG dyads for a Randomized Control Trial using a tailored Daily Engagement in Meaningful Activity (DEMA) intervention to improve the quality of life for both PwCI and their CGs. Instead of traditional in-person recruitment, telephone-based recruitment was a driving factor for successfully contacting participants. Using a state-wide healthcare system database, we identified 4133 potential participants who met study criteria and could identify a primary caregiver. By mailing study information to potential PwCI-CG dyads, we observed a significant increase in initial contact, returned calls, and general interest in study participating. In-person recruitment, direct referrals from physicians in the clinic setting, and partnered local agencies were among the least successful strategies for establishing initial contact and recruiting dyads. After implementing new recruitment strategies, we recruited 152 dyads in 16 months (mean = 10 dyads/month). We found that establishing a monthly recruitment goal was a beneficial strategy. The healthcare system database, followed by an organizational registry, demonstrated higher rates of making initial contact and reaching eligible dyads (46% and 37%, respectively). Specific dyadic recruitment challenges included finding a suitable CG to participate and the extended follow-up timeframe from initial contact to screening and enrollment. There is a growing need to better understand successful strategies for didactic recruitment, particularly among older PwCI and their CGs