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Prevalence of Social Determinants of Health Risk Factors Among and Their Impact on Viral Suppression, Consistent Visits, and No-Show Rates Among Persons with HIV Who Identify as Hispanic
No full textThe current study examines the association between language preference, social determinants of health (SDOH) risk factors, viral load, and HIV care outcomes among individuals of Hispanic ethnicity in the United States. More than half (54%) of all participants reported having two or more unmet needs. Hispanic individuals were more likely to be at risk in 2 or more domains than their non-Hispanic counterparts. Food insecurity was the most common risk factor reported and when present, 51% of patients also reported financial resource strain. Surprisingly, when language preference was analyzed, English-preferring Hispanic patients were at higher risk of financial resource strain, daily stress, and food insecurity compared to those who preferred Spanish. When accounting for birthplace, Hispanic patients born in the US reported higher rates of daily stress, food insecurity, and unavailable transportation compared to Hispanic patients born in Puerto Rico or elsewhere outside the US. Increased SDOH risk factors including financial resource strain, housing and utilities strain, and limited transportation access were significantly associated with higher rates of no-shows to HIV clinic appointments but not with increased viral load or consistent completed clinic visits. In a mixed-effects model, each additional at-risk domain correlated to a 0.198 increase in the no show rate. This model also demonstrates higher rates of no-show visits in English-preferring Hispanic patients compared to Spanish-preferring patients. Overall, SDOH risk factors were commonly reported in our population and their presence were associated with higher no-show rates but not with viral suppression
Exploring the Connection Between RNA Splicing and Intellectual Disability
No full textIntellectual disability (ID) is a broad diagnostic category that encompasses individuals with impaired cognitive ability. While these disorders have heterogeneous causes, recent developments in next-generation sequencing (NGS) are revealing the prevalence of genetic etiologies. In particular, germline mutations in genes that affect RNA splicing are increasingly common causes of ID disorders. Research to elucidate the functional relationship between splicing and neurodevelopment is critical since molecular therapeutics require a nuanced understanding of the pathological mechanism. In this review, we first summarize the trends that have led to the discovery of the RNA splicing–ID relationship, then discuss recent progress and future directions for research surrounding RNA splicing in neurodevelopment. Finally, we speak on how these results may serve as the foundation for burgeoning therapies
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Role of Imaging in Newly Diagnosed WHO Grade II Diffuse Glioma in Adults: Update
No full textTarget population: Adult patients with suspected or histologically proven WHO Grade II diffuse glioma. Question 1: In adult patients with suspected or histologically proven WHO Grade II diffuse glioma, do advanced MRI techniques using magnetic resonance spectroscopy, perfusion weighted imaging or diffusion weighted imaging provide superior assessment of tumor grade, margins, progression, treatment-related effects, and prognosis compared to standard neuroimaging? Recommendation: Level II: The use of diffusion imaging and dynamic susceptibility contrast (DSC), dynamic contrast enhancement (DCE) and arterial spin labeling (ASL) sequences are suggested to differentiate WHO Grade II diffuse glioma from higher grade gliomas when this is not accomplished by T2 weighted and pre- and post-gadolinium contrast enhanced T1 weighted imaging. Level III: The use of diffusion and perfusion is suggested for obtaining information in genomics, prognosis, and post treatment monitoring when this information would be of value to the clinician and is not obtained through other methods. Level III: The use of MR Spectroscopy is suggested to differentiate WHO Grade II diffuse glioma from higher grade gliomas when this is not accomplished by standard MRI, perfusion and diffusion techniques and when such information would be of value to the clinician. Question 2: In adult patients with suspected or histologically proven WHO Grade II diffuse glioma, does molecular imaging using amino acid PET tracers provide superior assessment of tumor grade, margins, progression, treatment-related effects, and prognosis compared to standard neuroimaging? Recommendation: Level III: If not already evident by MRI studies, the addition of amino acid PET with FET and FDOPA as a tracer is suggested to help determine if a brain lesion is a low grade glioma or high grade glioma. Level III: If the standard clinical prognostic parameters are unclear and novel PET tracers are available, the clinician may consider FET to assist in determination of prognosis in an individual with grade II diffuse glioma. Level III: Clinicians may use FDOPA PET in addition to MRI if additional information is required for detection of tumor progression
Functionalizing Polyethersulfone Membranes: Using Nmr to Avoid Pitfalls When Using Uv-Induced Polymerization to \u27Graft From\u27 Surfaces
No full textFor nearly 30 years, UV-induced free radical polymerization has been used to modify the surface chemistry of polyethersulfone (PES) membranes, films, and coatings. The initial mechanism for the grafting process was introduced in the 1990s and supported without direct evidence of covalent bond formation. Since then, claims of ‘grafting from’ membranes in the literature rely on similar evidence using a combination of gravimetry, attenuated total reflectance infrared spectroscopy, contact angle goniometry, water sorption, and/or water permeance. While these techniques provide evidence of the presence of a polymer coating, they do not provide direct evidence of covalent bond formation between the grafted polymer and the PES membrane or support. Thus, it is possible to mischaracterize a physisorbed film as a chemically bonded grafted polymer. We use experimental data from a model system to examine two key areas: 1) the impact of experimental parameters (UV intensity, UV wavelength, grafting time, and monomer concentration) on the degree of grafting and 2) the limitations of the current literature-accepted techniques used to characterize surfaces functionalized by UV-grafting. NMR is introduced as a technique to quantitatively analyze grafting from a PES membrane and is compared directly to the literature-accepted techniques to expose ‘false positives’ that may lead to incorrect conclusions about ‘grafting from’. Finally, we use 2D NMR techniques to present direct evidence of covalent bond formation from the UV-initiated reaction between a model PES monomer and a model methacrylate monomer in solution
Redefining Cancer Photodynamic Therapy with Gold Nanoparticles
No full textDespite advancements made in treatment options, cancer continues to be one of the leading causes of death worldwide. Photodynamic therapy (PDT) has gained attention as a minimally invasive and highly selective treatment option for cancer. However, challenges due to the hydrophobicity of photosensitizers and their poor tumor selectivity have limited their use in cancer therapy. Recent developments in nanotechnology, particularly the use of gold nanoparticles (AuNPs), help overcome these challenges. AuNPs provide a stable and biocompatible platform to deliver photosensitizers, improving their solubility, stability, and ability to target tumors while reducing side effects. Functionalized AuNPs take advantage of mechanisms like the enhanced permeability and retention (EPR) effect and active targeting, improving reactive oxygen species (ROS) production and overall therapeutic efficacy. This review explores innovations in AuNP-based PDT systems, including ligand-functionalized nanoparticles, bioresponsive coatings, and theranostic approaches that combine imaging with therapy. By delving into important aspects of synthesis, characterization, and functionalization, we show how AuNPs improve the delivery and performance of photosensitizers. For instance, systems functionalized with prostate-specific membrane antigen (PSMA) have shown increased therapeutic precision and efficacy in vivo. These advancements are paving the way for more targeted and safer cancer treatments, establishing AuNP-based PDT as a promising approach for developing highly effective oncological therapies with greater precision and fewer side effects
Nerve Transfers for Median Nerve Injury
No full textDue to its role in hand function, median nerve injuries can have a significant impact on patients’ lives. Nerve transfers can be performed alone or in conjunction with tendon transfers to restore critical functions supplied by the median nerve, with a particular emphasis on restoring grasp, pinch, and sensation. Continued study into possible nerve transfers for median nerve injury has led to multiple options that can be tailored to the patient\u27s demands, deficits, and injury pattern
Management of Severe Gingival Recession Using a Double Papilla Connective Tissue Graft: A 2-Year Follow-Up Case Study
No full textGum recession is a common condition where the gum tissue pulls away from the teeth, exposing the roots and making them more prone to damage. This report describes the treatment of a 30-year-old woman who had severe gum recession on her lower left canine tooth, caused by her long-term habit of scratching the gums with her fingernail. To restore the lost tissue and protect the tooth, a double papilla flap (a surgical technique that moves nearby tissue) along with a connective tissue graft (transplanted tissue from the roof of the mouth) was used. Over 2 years, the recession was reduced by almost 90%, and the tissue over the tooth became healthier and stronger. Although her habit caused some recession to return, the thickened tissue allowed for natural healing once she controlled her habit again. This case highlights how proper surgical technique selection and execution, combined with patient behavior changes, can successfully treat severe gum recession. It also demonstrates how ultrasound imaging can be used as a non-invasive tool to monitor soft tissue healing over time
Distributed Tikhonov Regularization for Ill-Posed Inverse Problems from a Bayesian Perspective
No full textIn this article, we exploit the similarities between Tikhonov regularization and Bayesian hierarchical models to propose a regularization scheme that acts like a distributed Tikhonov regularization where the amount of regularization varies from component to component, and a computationally efficient numerical scheme that is suitable for large-scale problems. In the standard formulation, Tikhonov regularization compensates for the inherent ill-conditioning of linear inverse problems by augmenting the data fidelity term measuring the mismatch between the data and the model output with a scaled penalty functional. The selection of the scaling of the penalty functional is the core problem in Tikhonov regularization. If an estimate of the amount of noise in the data is available, a popular way is to use the Morozov discrepancy principle, stating that the scaling parameter should be chosen so as to guarantee that the norm of the data fitting error is approximately equal to the norm of the noise in the data. A too small value of the regularization parameter would yield a solution that fits to the noise (too weak regularization) while a too large value would lead to an excessive penalization of the solution (too strong regularization). In many applications, it would be preferable to apply distributed regularization, replacing the regularization scalar by a vector valued parameter, so as to allow different regularization for different components of the unknown, or for groups of them. Distributed Tikhonov-inspired regularization is particularly well suited when the data have significantly different sensitivity to different components, or to promote sparsity of the solution. The numerical scheme that we propose, while exploiting the Bayesian interpretation of the inverse problem and identifying the Tikhonov regularization with the maximum a posteriori estimation, requires no statistical tools. A clever combination of numerical linear algebra and numerical optimization tools makes the scheme computationally efficient and suitable for problems where the matrix is not explicitly available. Moreover, in the case of underdetermined problems, passing through the adjoint formulation in data space may lead to substantial reduction in computational complexity
Self-Management for People with Epilepsy and a History of Negative Health Events (Smart): A Randomized Controlled Effectiveness Trial
No full textObjectives: This 2-site, 6-month randomized controlled trial of an epilepsy self-management (ESM) curriculum (SMART) vs. 6-month waitlist (WL) control assessed effects on epilepsy outcomes in 160 people with epilepsy (PWE). Methods: PWE had at least 1 negative health event (NHE) defined as a seizure, emergency department visit, hospitalization or self-harm attempt in the last 6 months. Primary outcomes were differences in proportions of PWE with reductions in NHEs from baseline to 6 months follow up and change in NHE/seizure counts between SMART and WL. Secondary outcomes included the Patient Health Questionnaire (PHQ-9), 36-Item Short Form Survey (SF-36), Quality of Life in Epilepsy (QOLIE-31), Epilepsy Self-Management Scale (ESMS), Epilepsy Stigma Scale (ESS), Multidimensional Scale of Perceived Social Support (MSPSS) and Epilepsy Self-Efficacy Scale (ESES). Results: Mean age was 39.4 (SD 12.2), 66.9 % (N = 107) women, and 31 % (N = 50) rural. Mean PHQ-9 of 10.5 (SD 7) suggested mild/moderate depression. Seizures were the most common NHE with mean baseline past 6-month seizure count of 20.6 (SD 41.0). SMART was significantly associated with a 2-fold increase in odds of having at least 10–30 % improvement in NHEs vs. WL (p \u3c 0.05). SMART was associated with significant seizure reduction (p \u3c 0.05), significantly improved PHQ-9 (p = 0.014), QOLIE-31 seizure worry (p = \u3c0.001) and social functioning (p = 0.021), ESES (p = 0.046) and ESMS (p \u3c 0.001). Significance: Compared to WL, SMART participants had improvement in NHEs and seizures, depressive symptoms, self-management competency and self-efficacy and selected elements of quality of life. Inclusion of effective ESMs into a comprehensive care of model for PWE may be warranted
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