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US Neonatal Intensive Care Unit Registered Dietitian Nutritionists Salary Description and Correlates: Results of a Survey
Get PDFBackground: This survey described the compensation of neonatal intensive care unit (NICU) registered dietitian nutritionists (RDNs) in the United States and examined correlates of higher salaries within this group. Methods: A cross-sectional online survey was completed in 2021 by 143 NICU RDNs from 127 US hospitals who reported hourly wage in US dollars (USD). We used initial bivariate analyses to assess the relationship of selected institution-level and individual-level variables to hourly wage; the rank-sum test for binary variables; bivariate regression and Pearson correlation coefficients for continuous variables; the Kruskal–Wallis test for categorical variables. Variables with a compelling relationship to the hourly wage outcome were considered in model creation. Final model selection was based on comparisons of model fit. Results: Median hourly compensation was USD 33.24 (interquartile range [IQR] 29.81, 38.49). Seven variables had a compelling bivariate relationship with hourly wage: cost of living, employer facility with a paediatric residency, employer facility with a neonatal fellowship, NICU bed: full-time equivalents (FTE) RDN ratio, years in neonatal nutrition, having a certification and order writing privileges. In the final adjusted model (R2 = 0.42), three variables remained associated with increased hourly wage: higher cost of living, longer length of career in neonatal nutrition and fewer NICU beds per NICU RDN FTE. Conclusions: US NICU RDNs earn similar or slightly higher wages than other US paediatric RDNs; they earn substantially less than other NICU healthcare team members. Employers need to improve compensation for NICU RDNs to incentivise their retention and recognise their additional non-clinical responsibilities
Violence Exposure and Trauma Screener for Youth (VETSY)
No full textBackground: Youth exposed to violence are at serious risk for physical, emotional, behavioral, and mental distress. Reliable and prompt detection is necessary to mitigate the psychological consequences of youth violence exposure and trauma. Objective: To describe the initial creation of the VETSY screener and its construct validity and potential use. Methods: From 2014 through 2022 we surveyed 20,532 at-risk youth aged 8–18 years from a diverse metropolitan community participating in the Defending Childhood Initiative (DCI). Youth completed a 17-item self-report screener. An Exploratory Factor Analysis (EFA) was used to determine the reliability and variable grouping for this brief screener. Violence exposure, violent behaviors, and trauma symptoms were assessed. Responses were evaluated based on youth demographics. A potential cutoff score meriting further assessment and intervention was established. Results: Sixty-seven percent of youth reported at least one type of violence exposure within the last year, 55 % reported perpetrating at least one type of violent behavior, and 68 % of youth reported at least one trauma symptom. An Exploratory Factor Analysis (EFA) with a geomin (oblique) rotation was applied and yielded a three-factor model with high loadings and acceptable fit for violence exposure, violent behaviors, and trauma symptoms. Additional analyses showed the screener structure was the same across sex, race and age groups. Conclusions: The use of the brief screener to quickly and reliably assess violence exposure, violent behaviors, and trauma symptoms among youth provides an opportunity for mental health providers to detect and refer at-risk youth for additional assessment and treatment
Synergistic Effects of Biological Stimuli and Flexion Induce Microcavities Promote Hypertrophy and Inhibit Chondrogenesis During In Vitro Culture of Human Mesenchymal Stem Cell Aggregates
No full textInterzone/cavitation are key steps in early stage joint formation that have not been successfully developed in vitro. Further, current models of endochondral ossification, an important step in early bone formation, lack key morphology morphological structures such as microcavities found during development in vivo. This is possibly due to the lack of appropriate strategies for incorporating chemical and mechanical stimuli that are thought to be involved in joint development. We designed a bioreactor system and investigated the synergic effect of chemical stimuli (chondrogenesis-inducing [CIM] and hypertrophy-inducing medium [HIM]) and mechanical stimuli (flexion) on the growth of human mesenchymal stem cells (hMSCs) based linear aggregates under different conditions over 4 weeks of perfusion culture. Computational studies were used to evaluate tissue stress qualitatively. After harvesting, both Safranin-O and hematoxylin & eosin (H&E) staining histology demonstrated microcavity structures and void structures in the region of higher stresses for tissue aggregates cultured only in HIM under flexion. In comparison to either HIM treatment or flexion only, increased glycosaminoglycan (GAG) content in the extracellular matrix (ECM) at this region indicates the morphological change resembles the early stage of joint cavitation; while decreased type II collagen (Col II), and increased type X collagen (Col X) and vascular endothelial growth factor (VEGF) with a clear boundary in the staining section indicates it resembles the early stage of ossification. Further, cell alignment analysis indicated that cells were mostly oriented toward the direction of flexion in high-stress region only in HIM under flexion, resembling cell morphology in both joint cavitation and hypertrophic cartilage in growth plate. Collectively, our results suggest that flexion and HIM inhibit chondrogenesis and promote hypertrophy and development of microcavities that resemble the early stage of joint cavitation and endochondral ossification. We believe the tissue model described in this work can be used to develop in vitro models of joint tissue for applications such as pathophysiology and drug discovery
The Public Performativity of Trust
Get PDFBuilding trust between academic medical centers and certain communities they depend on in the research process is hard, particularly when those communities consist of minoritized or historically marginalized populations. Some believe that engagement activities like the creation of advisory boards, town halls, or a research workforce that looks more like community members will establish or reestablish trust between academic medical centers and racialized communities. However, without systematic approaches to dismantle racism, those well-intended actions become public performativity, and trust building will fail. In this essay, we draw upon foundational ethical principles of trust, distrust, and trust building; apply the concept of bounded justice to performative trust acts; and center the works of Black and Indigenous feminist bioethicists to revisit some of the wisdom and valuable lessons they have contributed. Rebuilding trust is hard to do because people and institutions are often not honest about how hard it is and there is no simple box-checking task that can disentangle our society\u27s injustices, but there are steps to take in this direction. Individuals and institutions can recognize valuable relevant work that has already been written, partake in critical reflection, and then apply insights gained to take both small and sustainable steps toward transformational change and deeper trust
Exploring the Inhibition of the Soluble Lytic Transglycosylase Cj0843c of \u3ci\u3eCampylobacter jejuni\u3c/i\u3e via Targeting Different Sites with Different Scaffolds
Get PDFBacterial lytic transglycosylases (LTs) contribute to peptidoglycan cell wall metabolism and are potential drug targets to potentiate β-lactam antibiotics to overcome antibiotic resistance. Since LT inhibitor development is underexplored, we probed 15 N-acetyl-containing heterocycles in a structure-guided fashion for their ability to inhibit and bind to the Campylobacter jejuni LT Cj0843c. Ten GlcNAc analogs were synthesized with substitutions at the C1 position, with two having an additional modification at the C4 or C6 position. Most of the compounds showed weak inhibition of Cj0843c activity. Compounds with alterations at the C4 position, replacing the -OH with a -NH2, and C6 position, the addition of a -CH3, yielded improved inhibitory efficacy. All 10 GlcNAc analogs were crystallographically analyzed via soaking experiments using Cj0843c crystals and found to bind to the +1 +2 saccharide subsites with one of them additionally binding to the −2 −1 subsite region. We also probed other N-acetyl-containing heterocycles and found that sialidase inhibitors N-acetyl-2,3-dehydro-2-deoxyneuraminic acid and siastatin B inhibited Cj0843c weakly and crystallographically bound to the −2 −1 subsites. Analogs of the former also showed inhibition and crystallographic binding and included zanamivir amine. This latter set of heterocycles positioned their N-acetyl group in the −2 subsite with additional moieties interacting in the −1 subsite. Overall, these results could provide novel opportunities for LT inhibition via exploring different subsites and novel scaffolds. The results also increased our mechanistic understanding of Cj0843c regarding peptidoglycan GlcNAc subsite binding preferences and ligand-dependent modulation of the protonation state of the catalytic E390
The Role of Primary Care in Improving Population Health
Get PDFIn widely quoted ecological analyses, primary care is associated with population health. Not only with population health, but with health equity, health care quality, and lower health care expenditure - a pretty good definition of value. Yet, there is a paradox about primary care. Despite these desirable population‐level attributes, at the disease level at which we typically measure, incentivize, and organize the work of health care, when assessed with one‐disease‐at‐a‐time quality measures, primary care does not perform as well as care focused on a single disease. What is going on here? In caring for patients’ individual diseases, primary care appears to offer lower quality than specialty care. But at the population level of countries, systems, and municipalities—if we organize around primary care, we get better health, equity, quality, and value? How can this be? Apparently there are some emergent properties of primary care in which a relationship with the whole—person, family, community—is more than the sum of its parts. Not understanding this paradox, indeed feeling threatened by it, leads us to act on many potential health drivers in ways that do not have the intended effects on the health of people and populations and that indeed often make things worse. This paper explores the ways in which primary care might influence population health by serving as a force for integration across the often‐fragmented systems influencing population health. In the course of that exploration, we will examine the complexly related mechanisms by which the craft of general practice, as a vital component of primary health care, leads to the emergent properties of health, equity, quality, and sustainable resource use. Then, we will consider two informative stories—one of a person living with multiple chronic conditions and social disadvantage, and a second person who is overserved and whose problems and opportunities do not fit neatly into little boxes. Next, we will examine how primary care might helpfully interact with the other influencers of population health investigated in this special issue of The Milbank Quarterly. We close with policy recommendations for federal, state, and health care system leaders
Aggressive End-of-Life Care Across Gradients of Cognitive Impairment in Nursing Home Patients with Metastatic Cancer
No full textBackground: Studies examining end-of-life (EOL) care in older cancer patients are scarce, and prior studies have not accounted for gradients of cognitive impairment (COG-I). We examine EOL care patterns across COG-I gradients, hypothesizing that greater COG-I severity is associated with lower odds of receiving aggressive EOL care. Methods: Using data from the linked Surveillance Epidemiology and End Results (SEER) -Medicare -Minimum Data Set (MDS) 3.0, we identified patients with nursing facility stays (NFS) and who died with metastatic cancer from 2013 to 2017. Markers of aggressive EOL care were: cancer-directed treatment, intensive care unit admission, \u3e1 emergency department visit, or \u3e1 hospitalization in the last 30 days of life, hospice enrollment in the last 3 days of life, and in-hospital death. In addition to descriptive analysis, we conducted multivariable logistic regression analysis to evaluate the independent association between COG-I severity and receipt of aggressive EOL care. Results: Of the 40,833 patients in our study population, 49.2% were cognitively intact; 24.4% had mild COG-I; 19.7% had moderate COG-I; and 6.7% had severe COG-I. The percent of patients who received aggressive EOL care was 62.6% and 74.2% among those who were cognitively intact and those with severe COG-I, respectively. Compared with cognitively intact patients, those with severe COG-I had 86% higher odds of receiving any type of aggressive EOL care (adjusted odds ratio (aOR): 1.86 (95% confidence interval: 1.70–2.04)), which were primarily associated with higher odds of in-hospital death. The odds of in-hospital death associated with severe COG-I were higher among those with short- than with long-term stays (aOR:2.58 (2.35–2.84) and aOR:1.40 (1.17–1.67), respectively). Conclusions: Contrary to our hypothesis, aggressive EOL care in older metastatic cancer patients with NFS was highest among those suffering severe COG-I. These findings can inform the development of interventions to help reduce aggressive EOL care in this patient population
Nussbaum’s Politics of Wonder: How the Mind’s Original Joy Is Revolutionary
No full textKeymer explores how wonder is central to Martha C. Nussbaum’s normative project. Nussbaum’s work is opposed to the emotional and political conditions of ‘narcissism’ – the tendency to seek to control the wills of others in order to defend oneself against perceived vulnerabilities. Our capacity for wondering is important for growing beyond narcissism. Bendik-Keymer elaborates a politics of wonder that is consistent with understanding this idea. Taking issue with understandings of wonder viewing it as an emotion of surprise or delight, he develops an alternate tradition finding wonder in concert with the freedom of imagination found by degrees within much of human understanding. The result is a constructive rereading of Nussbaum’s oeuvre, surprising for how it disencumbers her work of some falsehoods surrounding anxiety and anger and for the ways it implies an egalitarian politics of relational autonomy more socialist than liberal. Misty Morrison’s visual inquiry accompanies the book creating space for the reader to wonder. Morrison paints and prints how families involve wonder, starting with moments in her child’s life when she wonders what they might see. Nussbaum’s Politics of Wonder is an important contribution to the philosophy of wonder and is crucial for understanding the work of a leading philosopher
Low-Cost, 3D Printed Irradiation System for In Vitro Photodynamic Therapy Experiments
Get PDFThe development of a suitable irradiation setup is essential for in vitro experiments in photodynamic therapy (PDT). While various irradiation systems have been developed for PDT, only a few offer practical and high-quality setups for precise and reproducible results in cell culture experiments. This report introduces a cost-effective illumination setup designed for in vitro photodynamic treatments. The setup consists of a commercially available light-emitting diode (LED) lamp, a cooling unit, and a specially designed 3D-printed enclosure to accommodate a multiwell plate insert. The LED lamp is versatile, supporting various irradiation wavelengths and adjustable illumination fields, ensuring consistent and reliable performance. The study evaluates the setup through various parameters, including photon flux density, illumination uniformity, photon distribution across the multiwell plate, and temperature changes during irradiation. In addition, the effectiveness of the LED-based illumination system is tested by treating mouse mammary breast carcinoma cells (4T1) with Rose Bengal and LED irradiation at around 525 nm. The resulting IC50 of 5.2 ± 0.9 μM and a minimum media temperature change of ca. 1.2°C indicate a highly promising LED-based setup that offers a cost-effective and technically feasible solution for achieving consistent, reproducible, and uniform irradiation, enhancing research capabilities and potential applications
Resilience as a Moderator of Role Overload and Sleep Disturbance Among Caregivers of Persons with Dementia
Get PDFThe purpose of this study was to examine if resilience moderates the association between role overload and sleep disturbance among caregivers of persons with dementia. This was a secondary analysis of data on 437 informal caregivers (mean age=61.77 years, SD=13.69) of persons with dementia in the United States. Data from the 2017 wave of the National Study of Caregiving were analyzed using multiple regression with interaction terms to evaluate the moderation effect of resilience, while controlling for caregivers’ age, race, gender, education, self-rated health, caregiving hours, and primary caregiving status. Higher role overload was associated with greater sleep disturbance and this association was attenuated among caregivers with higher levels of resilience. Our findings highlight the stress-buffering effects of resilience in the context of sleep disturbance in dementia caregivers. Interventions to improve caregivers’ ability to recover, resist, and rebound during challenging situations may mitigate role overload and optimize sleep health
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