Bulletin of Computer Science and Electrical Engineering (BCSEE)
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Cultural Humility Toolkit
No full textBACKGROUNDDiversity, equity, and inclusion (DEI) are increasingly recognized as core values for nursing education and practice. PURPOSEThe purpose of this article is to offer teaching tools and strategies to integrate cultural humility within the nursing curriculum and create a more inclusive learning environment. APPROACHVarious teaching tools, methods, and strategies are presented. OUTCOMESUse of ground rules, an environmental assessment, examination of the curriculum landscape and teaching materials, bias awareness activity, modified privilege walk, Modified Monopoly, simulation, low-income community experiences, study abroad, debriefing, and evaluation with valid and reliable tools are suggested. CONCLUSIONSBy threading cultural humility concepts throughout the curriculum, nurse educators have the potential to shape learner perspectives to better appreciate and value diversity
Evaluating predictors of successful postoperative day 1 discharge following posterior fossa tumor resection
No full textAbstract
INTRODUCTION: Current trends in surgical neuro-oncology have shown that early discharges are both safe and feasible with shorter lengths of stay (LOS) associated with fewer thromboembolic complications, less hospital-acquired infections, reduced costs, and greater patient satisfaction. Traditionally, infratentorial tumor resections have been associated with longer LOS and limited data exists evaluating predictors of early discharge in these patients. The objective was to assess patients undergoing posterior fossa craniotomies for tumor resection and identify variables associated with a postoperative day 1 (POD1) discharge and determine any differences in outcomes and readmission rates. METHODS: A retrospective review of posterior fossa craniotomies for tumor resection at our institution was performed from 2011 to 2020. Laser ablations, craniotomies for non-tumoral pathologies, and biopsies were excluded. Complete demographic, clinical, surgical and postoperative data was collected for each patient. RESULTS: 173 patients were identified and 25 (14.5%) were discharged on POD1. Median length of stay was 6 days. The POD1 discharges had significantly better preoperative Karnofsky performance scores (p<0.001) and modified Rankin scores (p=0.002) and less frequently presented emergently (p=0.006) or with preoperative neurologic deficits (p=0.021). No statistically significant difference in 30-day readmissions and rates of PE, UTI, and DVT were found between the POD1 discharge cohort and those discharged later. Univariate logistic regression identified better preoperative functional status, elective admission, and lack of preoperative hydrocephalus as independent predictors of POD1 discharge however only the latter remained significant in the multivariable model (p=0.001). CONCLUSIONS: Discharging patients on POD1 is feasible following posterior fossa tumor resections and does not introduce any significant undue risk or result in higher readmissions. Although we found that the only independent predictor for a longer LOS was preoperative hydrocephalus, larger, prospective studies are needed to confirm these findings.</jats:p
Phase I/Ib Study of the Efficacy and Safety of Buparlisib and Ibrutinib Therapy in MCL, FL, and DLBCL with Serial Cell-Free DNA Monitoring
No full textActivation of Bruton tyrosine kinase (BTK) and phosphatidylinositol-3-kinase (PI3K) represent parallel, synergistic pathways in lymphoma pathogenesis. As predominant PI3Kδ inhibition is a possible mechanism of tumor escape, we proposed a clinical trial of dual BTK and pan-PI3K inhibition.
We conducted a single-center phase I/Ib trial combining a BTK inhibitor (ibrutinib) and a pan-PI3K inhibitor (buparlisib) in 37 patients with relapsed/refractory (R/R) B-cell lymphoma. Buparlisib and ibrutinib were administered orally, once daily in 28-day cycles until progression or unacceptable toxicity. The clinical trial is registered with clinicaltrials.gov, NCT02756247.
Patients with mantle cell lymphoma (MCL) receiving the combination had a 94% overall response rate (ORR) and 33-month median progression-free survival; ORR of 31% and 20% were observed in patients with diffuse large B-cell lymphoma and follicular lymphoma, respectively. The maximum tolerated dose was ibrutinib 560 mg plus buparlisib 100 mg and the recommended phase II dose was ibrutinib 560 mg plus buparlisib 80 mg. The most common grade 3 adverse events were rash/pruritis/dermatitis (19%), diarrhea (11%), hyperglycemia (11%), and hypertension (11%). All grade mood disturbances ranging from anxiety, depression, to agitation were observed in 22% of patients. Results from serial monitoring of cell-free DNA samples corresponded to radiographic resolution of disease and tracked the emergence of mutations known to promote BTK inhibitor resistance.
BTK and pan-PI3K inhibition in mantle cell lymphoma demonstrates a promising efficacy signal. Addition of BCL2 inhibitors to a BTK and pan-PI3K combination remain suitable for further development in mantle cell lymphoma
Prevalence of chewing difficulty in older people in long-term care: A systematic review and meta-analysis
No full textBackground Many factors can influence chewing, including age. The ageing process causes morphophysiological changes in the body, including in the performance of the stomatognathic system, which directly affect chewing and swallowing. Objective To determine the prevalence of chewing difficulty in older people in long-term care. Methods We searched six electronic databases and the grey literature. Qualitative and quantitative analyses, including risk of bias, were performed on studies that met the inclusion criteria. The meta-analysis of proportions with a random effects model was performed, and heterogeneity was explored by meta-regression. Risk of bias was determined using the Joanna Briggs Institute's Critical Appraisal Checklist. The certainty of evidence was verified using the GRADE tool. Results Twelve articles were included in the meta-analysis. The pooled prevalence estimate was 35% (95% confidence interval, 0.19-0.54). As heterogeneity still persisted even after sensitivity analysis, the predictors of mean sample age and sample size were meta-regressed to assess whether these covariates explained the variance between effect sizes. The covariable sample size of the study included in the analysis explained 84.3% of the heterogeneity existing in the analysis (R-2 = 84.3%; P = .0008). The risk of bias was low in three studies, eight studies had a moderate risk of bias and one study had a high risk of bias. As for the prevalence of chewing difficulty, the GRADE criteria were considered very low. Conclusion About one in three older people in long-term care have difficulty in chewing
Proposal on the use of Xenon-133 against COVID-19
No full textSince we are able to bring ionizing radiation in the form of a gas cloud to the respiratory system, we have wondered whether Xenon-133 inhalation could be exploited as a treatment option against Covid-19 respiratory virus infections, and urge colleagues in the scientific research community who have the capability to do so to explore the merits of using Xenon-133 in this way to determine whether its usefulness against the Covid-19 virus is indeed genuine.
•Perfusion of the respiratory system with ionizing radiation.•Auger electrons hypothesized impact on the Covid-19 virus.•Free radicals impacting the Covid-19 virus in the respiratory space
Robotics in Cerebrovascular and Endovascular Neurosurgery
No full textRobotic medicine has been adopted by various surgical subspecialties as its benefits have become more apparent. Vascular neurosurgery remains at the forefront of this cutting-edge technology. Here, we provide a broad overview of these innovations in vascular neurosurgery for both practitioners familiar with robotics and those seeking further edification on the subject. Technologies under development for cerebrovascular and endovascular neurosurgery include robot-assisted angiography, guided operative microscopes, coil insertion systems, and endoscopic clipping devices. Robotic technology has certain disadvantages, for example, wide implementation can lead to increased cost, training time, and potential delays in emergency situations. Further development of current multidisciplinary technologies and investigation into more recently developed systems is necessary before robotics can exert a significant effect on clinical practice
Specific polysubstance use patterns predict relapse among patients entering opioid use disorder treatment
No full text•Polysubstance use patterns over the 28-days pre OUD treatment were identified.•Polysubstance use patterns were differentially related to relapse during treatment.•Individuals using cocaine, heroin, opioids, and THC had a higher risk of relapse.•High levels of opioid use pre-treatment predicted high risk of relapse.•High levels of heroin use pre-treatment predicted high risk of relapse.
While polysubstance use has consistently been associated with higher rates of relapse, few studies have examined subgroups with specific combinations and time course of polysubstance use (i.e., polysubstance use patterns). This study aimed to classify and compare polysubstance use patterns, and their associations with relapse to regular opioid use in 2637 participants in three large opioid use disorder (OUD) treatment trials.
We explored the daily patterns of self-reported substance use in the 28 days prior to treatment entry. Market basket analysis (MBA) and repeated measure latent class analysis (RMLCA) were used to examine the subgroups of polysubstance use patterns, and multiple logistic regression was used to examine associations between identified classes and relapse.
MBA and RMLCA identified 34 “associations rules” and 6 classes, respectively. Specific combinations of polysubstance use and time course (high baseline use and rapid decrease of use prior to initiation) predicts a worse relapse outcome. MBA showed individuals who co-used cocaine, heroin, prescription opioids, and cannabis had a higher risk for relapse (OR = 2.82, 95%CI = 1.13, 7.03). In RMLCA, higher risk of relapse was observed in individuals who presented with high baseline prescription opioid (OR = 1.9, 95% CI = 1.3, 2.76) or heroin use (OR = 3.54, 95%CI = 1.86, 6.72), although use decreased in both cases prior to treatment initiation.
Our analyses identified subgroups with distinct patterns of polysubstance use. Different patterns of polysubstance use differentially predict relapse outcomes. Interventions tailored to these individuals with specific polysubstance use patterns prior to treatment initiation may increase the effectiveness of relapse prevention
Transcriptome and chromatin changes as regulatory T cells expand and contract to IL-2R signaling in vivo
No full textAbstract Regulatory T cells are essential to maintain peripheral T cell tolerance and require IL-2R signaling for their development and homeostasis. Here, we used mouse IL-2 (mIL-2) and a fusion protein of mouse IL-2 linked to mouse CD25 (mIL-2/CD25) to induce acute, periodic, and persistent IL-2R-dependent signaling in peripheral Tregs in vivo. RNA- and ATAC-seq assessed longitudinal shifts in the transcriptome and chromatin landscape to define the molecular steps associated with IL-2R-dependent Treg activation, expansion, and subsequent contraction in vivo. Analysis of the RNA-seq data revealed that STAT5 and MYC were two critical drivers of IL-2R-dependent signaling in Tregs. Other signaling pathways were also identified that facilitate cell transcription, integration of TCR signaling, cell cycle progression, and growth. Sustained IL-2R signaling by mIL-2/CD25, but not periodic signaling by mIL-2, more effectively supported Treg expansion, oxidative phosphorylation, and development into eTregs. With respect to chromatin remodeling, IL-2R signaling initially preferentially increased accessibility to binding sites and activity of STAT5, whereas more persistent IL-2R signaling favored accessibility and activity of other transcription factors, dominantly CTCF, followed by a genome-wide less accessible chromatin. Our data favor a model whereby persistent IL-2R signaling initially supports more accessible chromatin and active transcription leading to a metabolic shift toward a more energetic type required for Treg proliferation. Subsequently, as IL-2R signaling diminishes, a shift toward less accessible chromatin occurs that facilitates contraction of the expanded Tregs to restore homeostasis. This research was supported by funding from Bristol Myers Squibb and the NIH (R01AI148675)
How COVID-19 impacted child and family health and healthcare: a mixed-methods study incorporating family voices
No full textTo describe how social disruptions caused by the COVID-19 pandemic impacted child access to healthcare and child health behaviors in 2020. We used mixed-methods to conduct surveys and in-depth interviews with English- and Spanish-speaking parents of young children from five geographic regions in the USA. Participants completed the COVID-19 Exposure and Family Impact Survey (CEFIS). Semistructured telephone interviews were conducted between August and October 2020. Of the 72 parents interviewed, 45.8% of participants were Hispanic, 20.8% Black (non-Hispanic), and 19.4% White (non-Hispanic). On the CEFIS, the average (SD) number of social/family disruptions reported was 10.5 (3.8) out of 25. Qualitative analysis revealed multiple levels of themes that influenced accessing healthcare during the pandemic, including two broad contextual themes: (a) lack of trustworthiness of medical system/governmental organizations, and (b) uncertainty due to lack of consistency across multiple sources of information. This context influenced two themes that shaped the social and emotional environments in which participants accessed healthcare: (a) fear and anxiety and (b) social isolation. However, the pandemic also had some positive impacts on families: over 80% indicated that the pandemic made it "a lot" or "a little" better to care for their new infants. Social and family disruptions due to COVID-19 were common. These disruptions contributed to social isolation and fear, and adversely impacted multiple aspects of child and family health and access to healthcare. Some parents of infants reported improvements in specific health domains such as parenting, possibly due to spending more time together