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Fibrinogen; a Predictor of Injury Severity and Mortality Among Patients With Traumatic Brain injury in Sub-Saharan Africa: A Cross-Sectional Observational Study
No full textStudies show that fibrinogen concentrations \u3c2 g/L in patients with traumatic brain injury (TBI) is associated with increased mortality. However, little is known regarding fibrinogen levels and TBI severity as well as mortality in sub-Saharan Africa despite shouldering a high burden of TBI. We therefore set out to determine whether fibrinogen levels are associated with TBI severity and outcome. To determine the sensitivity and specificity of fibrinogen levels and the association with severity and mortality among TBI patients at Mulago Hospital. We prospectively enrolled 213 patients with TBI aged between 13 and 60 years of age and presenting within 24 hours of injury. Patients with preexisting coagulopathy, concurrent use of anticoagulant or antiplatelet agents, preexisting hepatic insufficiency, diabetes mellitus and who were pregnant were excluded. Fibrinogen levels were determined using the Clauss fibrinogen assay. Logistic regression analyses were conducted to identify the association between fibrinogen level and 7-day outcomes. Majority of the patients were male (88.7%) and nearly half were aged 30 or less (48.8%). Fibrinogen levels \u3c2 g/L were observed in 35.1% of the study participants. The average time spent in the study was 3.7 ± 2.4 days. The sensitivity and specificity using fibrinogen \u3c2 g/L was 56.5% and 72.9% respectively. Fibrinogen levels predict TBI severity with an AUC = 0.656 (95% CI 0.58-0.73: P = .000) Fibrinogen levels \u3c2 g/L (hypofibrinogenemia) were independently associated with severe TBI. (Adjusted odds ratio 2.87 CI, 1.34-6.14: P = .007). Levels above 4.5 g/L were also independently associated with injury severity (adjusted odds ratio 2.89, CI 1.12-7.48: P \u3c .05) Fibrinogen levels more than 4.5 g/L were independently associated with mortality (OR 4.5, CI; 1.47-13.61, P \u3c .05). The fibrinogen level is a useful tool in predicting severity including mortality of TBI. Fibrinogen levels may be used as an additional tool to screen TBI patients for injury severity especially among patients with Glasgow coma scale scores of \u3c14
Kindlin-3 Deficiency leads to Impaired Erythropoiesis and Erythrocyte Cytoskeleton
Get PDFKindlin-3 (K3) is critical for the activation of integrin adhesion receptors in hematopoietic cells. In humans and mice, K3 deficiency is associated with impaired immunity and bone development, bleeding, and aberrant erythrocyte shape. To delineate how K3 deficiency (K3KO) contributes to anemia and misshaped erythrocytes, mice deficient in erythroid (K3KO\EpoR-cre) or myeloid cell K3 (K3KO\Lyz2cre), knockin mice expressing mutant K3 (Q597W598 to AA) with reduced integrin-activation function (K3KI), and control wild-type (WT) K3 mice were studied. Both K3-deficient strains and K3KI mice showed anemia at baseline, reduced response to erythropoietin stimulation, and compromised recovery after phenylhydrazine (PHZ)-induced hemolytic anemia as compared with K3WT. Erythroid K3KO and K3 (Q597W598 to AA) showed arrested erythroid differentiation at proerythroblast stage, whereas macrophage K3KO showed decreased erythroblast numbers at all developmental stages of terminal erythroid differentiation because of reduced erythroblastic island (EBI) formation attributable to decreased expression and activation of erythroblast integrin α4β1 and macrophage αVβ3. Peripheral blood smears of K3KO\EpoRcre mice, but not of the other mouse strains, showed numerous aberrant tear drop–shaped erythrocytes. K3 deficiency in these erythrocytes led to disorganized actin cytoskeleton, reduced deformability, and increased osmotic fragility. Mechanistically, K3 directly interacted with F-actin through an actin-binding site K3-LK48. Taken together, these findings document that erythroid and macrophage K3 are critical contributors to erythropoiesis in an integrin-dependent manner, whereas F-actin binding to K3 maintains the membrane cytoskeletal integrity and erythrocyte biconcave shape. The dual function of K3 in erythrocytes and in EBIs establish an important functional role for K3 in normal erythroid function
The Effects of Poly(Ethylene Glycol) Grafting Density on the Extensional Solution Flows of High Molecular Weight Polyacrylamide
No full textControlling the extensional rheological properties of solutions is of great interest for a number of applications, such as printing and coatings, as polymeric additives can modify a fluid\u27s droplet size, formation, and breakup. We have measured the extensional flows of polyacrylamide graft poly(ethylene glycol) amine (PAM-g-PEGa) solutions as a function of grafting density. PAM-g-PEGa is synthesized with grafting densities of 2.5%, 5.5%, 8%, and 30% and extensional flow was analyzed with drop-on-substrate rheology. Flow time scales and profiles are then compared to understand the effects of backbone extension from the addition of side chains. At low grafting densities, the viscous friction from the added side chains is comparable to, and in some cases, counteracts the losses in extensibility to the graft polymer\u27s backbone, leading to increases in the relaxation time of the polymer. At higher grafting densities, the extension of the backbone reduces the relaxation time. By characterizing the effects of the graft density architecture on extensional flows, we are able to fine-tune and control the breakup dynamics of elastic solutions
Social Activity Restriction and Psychological Health Among Caregivers of Older Adults With and Without Dementia
Get PDFObjectives: We examined associations between social activity restriction and psychological distress and well-being for caregivers of older adults with and without dementia, and if the identified associations are different for the two groups. Methods: Using data from the 2017 National Study of Caregiving, we identified caregivers of older adults with (N = 541) and without (N = 1701) dementia. Linear regression models were estimated, adjusting for caregivers’ age, gender, race, education, relationship to care recipient, and self-rated health. Results: Restriction in visiting friends and family and attending religious services were associated with higher distress in dementia caregivers. Restriction in visiting friends and family was associated with higher distress and lower well-being in non-dementia caregivers. Any activity restriction had stronger association with distress for caregivers of older adults with versus without dementia. Discussion: Findings highlight the need for tailored interventions based on caregivers’ perceptions of meaningful social activities and dementia-friendly communities to promote social participation
Sickle Red Blood Cell-Derived Extracellular Vesicles Activate Endothelial Cells and Enhance Sickle Red Cell Adhesion Mediated by von Willebrand Factor
Get PDFEndothelial activation and sickle red blood cell (RBC) adhesion are central to the pathogenesis of sickle cell disease (SCD). Quantitatively, RBC-derived extracellular vesicles (REVs) are more abundant from SS RBCs compared with healthy RBCs (AA RBCs). Sickle RBC-derived REVs (SS REVs) are known to promote endothelial cell (EC) activation through cell signalling and transcriptional regulation at longer terms. However, the SS REV-mediated short-term non-transcriptional response of EC is unclear. Here, we examined the impact of SS REVs on acute microvascular EC activation and RBC adhesion at 2 h. Compared with AA REVs, SS REVs promoted human pulmonary microvascular ECs (HPMEC) activation indicated by increased von Willebrand factor (VWF) expression. Under microfluidic conditions, we found abnormal SS RBC adhesion to HPMECs exposed to SS REVs. This enhanced SS RBC adhesion was reduced by haeme binding protein haemopexin or VWF cleaving protease ADAMTS13 to a level similar to HPMECs treated with AA REVs. Consistent with these observations, haemin- or SS REV-induced microvascular stasis in SS mice with implanted dorsal skin-fold chambers that was inhibited by ADAMTS13. The adhesion induced by SS REVs was variable and was higher with SS RBCs from patients with increased markers of haemolysis (lactate dehydrogenase and reticulocyte count) or a concomitant clinical diagnosis of deep vein thrombosis. Our results emphasise the critical contribution made by REVs to the pathophysiology of SCD by triggering acute microvascular EC activation and abnormal RBC adhesion. These findings may help to better understand acute pathophysiological mechanism of SCD and thereby the development of new treatment strategies using VWF as a potential target
Gender Diversity Cultural Responsiveness Education in Speech-Language Pathology Graduate Programs: A Pilot Survey
Get PDFPurpose: Gender-affirming voice therapy aims to align a person’s voice and communication with their gender identity. Historically, transgender and gender-nonconforming (TGNC) individuals have been marginalized and continue to face significant healthcare disparities. The goal of this research was to examine the self-perceived preparedness of recent speech-language pathology (SLP) graduates for working with TGNC clients. A survey was developed to include both multiple choice and open-ended questions. Topics included graduate-level training on working with TGNC individuals, perceived preparedness to work with this client population, educational resources sought by respondents, and suggested improvements for SLP graduate programs. Thirty recent (since 2016) SLP graduates completed the survey anonymously. Although a majority (83%) of respondents reported that working with TGNC clients was addressed in their graduate education, 66% of respondents felt that instruction time spent on this topic was insufficient or slightly insufficient. Those who had clinical experiences with TGNC clients, or who learned from the perspectives of the TGNC community (e.g., from a guest speaker or video), reported that their graduate education better prepared them to work with TGNC clients. One of the most common recommendations to improve graduate education was to invite TGNC speakers to share their experiences. The majority of respondents identified a need for improvement of gender diversity education in SLP graduate programs. Further research is needed to determine the efficacy of different curricula in increasing the knowledge and skills of SLP graduates specific to TGNC clients to ensure clinical competency and equitable care
Exploring Niche Alteration in Nonprofit Organizations
Get PDFThe organizational niche is a concept integral to organizational ecology, reflecting an organization’s mission, expertise, capacity, and resource requirements. The choice of niche is crucial to the viability of the organization; however, the reasons organizations alter their niche are poorly understood. We hypothesize that nonprofit organizations alter their niche to reduce environmental pressure and gain access to resources. The results indicate that niche alteration predicts increases in total revenue with average increases in revenue from program services and contributions (depending on the measure). Additionally, nonprofits that are younger, larger, and have more concentrated revenue, are more likely to alter their niche
The Relationship between Religion, Substance Misuse, and Mental Health among Black Youth
Get PDFStudies suggest that religion is a protective factor for substance misuse and mental health concerns among Black/African American youth despite reported declines in their religious involvement. However, few studies have investigated the associations among religion, substance misuse, and mental health among Black youth. Informed by Critical Race Theory, we evaluated the correlations between gender, depression, substance misuse, and unprotected sex on mental health. Using multiple linear regression, we assessed self-reported measures of drug use and sex, condom use, belief in God, and religiosity on mental health among a sample of Black youth (N = 638) living in a large midwestern city. Results indicated drug use, and sex while on drugs and alcohol, were significant and positively associated with mental health symptoms. Belief in God was negatively associated with having sex while on drugs and alcohol. The study’s findings suggest that despite the many structural inequalities that Black youth face, religion continues to be protective for Black youth against a myriad of prevalent problem behaviors
Reflections on the Use of Patient Records: Privacy, Ethics, and Reparations in the History of Psychiatry
Get PDFOne of the most common questions we get asked as historians of psychiatry is “do you have access to patient records?” Why are people so fascinated with the psychiatric patient record? Do people assume they are or should be available? Does access to the patient record actually tell us anything new about the history of psychiatry? And if we did have them, what can, or should we do with them? In the push to both decolonize and personalize the history of psychiatry, as well as make some kind of account or reparation for past mistakes, how can we proceed in an ethical manner that respects the privacy of people in the past who never imagined their intensely personal psychiatric encounter as subject for future historians? In this paper, we want to think through some of the issues that we deal with as white historians of psychiatry especially at the intersection of privacy, ethics, and racism. We present our thoughts as a conversation, structured around questions we have posed for ourselves, and building on discussions we have had together over the past few years. We hope that they act as a catalyst for further discussion in the field
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