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Disparities in Chronic Stress Exposure and Appraisal and Later-Life Disability
No full textBackground and objectives: Influenced by the stress process theory, this study investigated the relationship between chronic stress (measured by exposure and appraisal) and the onset of a disability in later life among White, Black, U.S.-born Hispanic, and foreign-born Hispanic adults.
Research design and methods: Using nationally representative data from the Health and Retirement Study, I used Weibull accelerated failure time models to examine racial, ethnic, and nativity disparities in chronic stress exposure and appraisal and age of onset of disability during the following 8-10 years (i.e., incidence).
Results: Over time, earlier onset of disability was associated with higher levels of stress exposure (β = -0.04) and negative appraisals (β = -0.07). Appraising stress as more upsetting had a detrimental influence on later-life disability for Black adults (occurring 11% earlier), but a protective effect for foreign-born Hispanic adults (occurring 20% later) compared with White adults.
Discussion and implications: Overall, findings suggest it is important to acknowledge not just the exposure to chronic stressors, but how upsetting these chronic stressors make one feel to reduce racial, ethnic, and nativity disparities in disability
The Library is Not Enough: Building the Data Governance Community at Your Institution
No full textWhile many Open Science initiatives are initiated by or hosted within academic libraries, managing data and open science practices requires the broad engagement of offices and departments across the institution. This engagement is often documented in data governance, which is “a system of decision rights and accountabilities for information-related processes, executed according to agreed-upon models which describe who can take what actions with what information, and when, under what circumstances, using what methods” (Data Governance Institute). While data governance may be established for administrative and institutional data, such as financial or student data, the evolving policy landscape and interests in open science have created new needs related to research data governance.
While some universities have established these practices, many academic institutions are still beginning to develop or refine the guidance and support that researchers are requesting. Research data governance practices might include: creation and maintenance of data policies, developing infrastructure for data retention, establishing and refining data workflows, and ensuring that the institution meets legal, funder, and publisher obligations for open sharing. Academic librarians already provide leadership in Open Science by creating resources like institutional or data repositories, engaging in outreach and instruction with students and faculty, and fostering communities of practice across disciplines. They further bring awareness of the gaps between administrative needs, compliance requirements, and the goals of research teams. A next step for librarians is to participate in or direct data governance activities at their institution. In this recipe, we will prompt readers to identify the pantry of data governance activities present or absent at their institution and create a shopping list of goals. Some example activities might include: documenting data governance challenges present at their institution, identifying relevant policies at their institution, identify the stakeholders in those policies, identify the owners and processes for policy change/creation of standards or procedures, and engaging faculty and leaders in conversation about the policy and process gaps at their institution
Utilizing near-peer teaching to expand obesity medicine training within an internal medicine residency curriculum
No full textObjectives: Obesity management is within the scope of an internist's practice in the primary care setting; however, physicians feel unprepared to address the topic. Many internal medicine (IM) residency programs struggle to include obesity management in their curricula. The objective of our study is to assess the self-reported knowledge and comfort of IM residents when addressing overweight and obesity following a near-peer teaching session on the subject.
Methods: A near-peer teaching session on the topic of overweight and obesity was presented in morning report format for IM residents. Pre-session, immediate post-session, and three-month follow-up surveys were completed to compare comfort and self-reported knowledge on obesity management in relation to the session. Z-test was used to analyze answers between survey time points.
Results: Out of fifty-one eligible residents, forty-one residents attended the teaching session. Thirty-three residents responded to the pre-session survey, twenty-five to the immediate post-session survey, and eighteen to the three-month follow-up survey. At baseline, residents recognized obesity as a chronic medical condition and were willing to address the topic with patients. Between pre- and immediate post-session surveys, residents demonstrated increased self-reported knowledge in recognizing BMI cutoffs, criteria for bariatric surgery, comfort offering dietary advice, documentation of obesity as a diagnosis, awareness of obesity management tools including nutrition services and willingness to provide them to patients. At the three-month follow-up survey, there was retention of BMI cutoffs and nutrition service availability, but there were partial losses in self-reported knowledge of criteria for bariatric surgery and locating obesity management tools.
Conclusions: A near-peer led teaching session in a morning report style format can increase residents' self-reported knowledge and comfort when addressing overweight and obesity, without overburdening the curriculum. Spaced review of the topic may overcome the partial knowledge losses seen in our IM resident population
FUSION: a web-based application for in-depth exploration of multi-omics data with brightfield histology
No full textSpatial technologies examining the cell and tissue microenvironment at near single-cell resolution are revealing important molecular insights. However, few tools enable integrated, interactive analysis of spatial-omics with tissue morphology in the same functional tissue unit. Here, we present FUSION (Functional Unit State Identification in Whole Slide Images), a web-based platform for visualizing and analyzing spatial-omics data with high-resolution histology. FUSION provides workflows for assessing cell compositions, quantitative morphometrics, and comparative tissue analyses. We demonstrate applicability across spatial assays, including 10x Visium, Visium HD, 10x Xenium, Cell DIVE, and PhenoCycler, applied to healthy and diseased tissues from kidney, small intestine, lung, and skin in the Human BioMolecular Atlas Program. FUSION is cloud-based, open-source, and accessible at https://fusion.hubmapconsortium.org/ , hosting over 50 paired datasets and tutorials. In a series of use cases, we show its capacity to distinguish renal glomeruli injury states, quantify morphometric changes, and characterize fibrosis with immune infiltration
Toxicity analysis of gold nanoparticle formulations used for intraocular applications
No full textGold nanoparticles (AuNPs) possess unique properties for various biological and intraocular applications. In retina research, AuNPs hold promise for therapeutic intervention, drug delivery, and photoreceptor replacement, but their potential toxicity is an area of concern. This study assesses the toxicity of AuNPs formulations suitable for photoreceptor replacement in retinal cells and tissue. Three different gold formulations were studied. One in the form of a single gold nanoparticle with citrate groups (AuNP), an AuNP coated with linkers and superhydrophobic layers (NC), and the NCs mounted on a BaTiO3 nanocore with a high dielectric constant (BTNC). Proliferation assays (PA) and terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assays with different concentrations of AuNPs, NC, and BTNC were conducted on human retinal endothelial cell (hREC) cultures. Following intravitreal injection (IVI) of nanoparticles in wild type (WT) mice, function was evaluated with electroretinography (ERG), structural changes through optical coherence tomography (OCT), and vascular change with Isolectin B4 (IB4) postmortem staining. No significant cell death or decreased growth were observed at concentrations below 100ppm in vitro (p-value > 0.05). Mice were examined before and after IVI with nanoparticles, and no major changes were seen. These findings indicate that AuNPs can cause a transient change in the electrophysiology of normal tissue and may impose structural changes at higher concentrations
Multi-Modal Fusion of Routine Care Electronic Health Records (EHR): A Scoping Review
No full textBackground: Electronic health records (EHR) are now widely available in healthcare institutions to document the medical history of patients as they interact with healthcare services. In particular, routine care EHR data are collected for a large number of patients. These data span multiple heterogeneous elements (i.e., demographics, diagnosis, medications, clinical notes, vital signs, and laboratory results) which contain semantic, concept, and temporal information. Recent advances in generative learning techniques were able to leverage the fusion of multiple routine care EHR data elements to enhance clinical decision support.
Objective: A scoping review of the proposed techniques including fusion architectures, input data elements, and application areas is needed to synthesize variances and identify research gaps that can promote re-use of these techniques for new clinical outcomes.
Design: A comprehensive literature search was conducted using Google Scholar to identify high impact fusion architectures over multi-modal routine care EHR data during the period 2018 to 2023. The guidelines from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping review were followed. The findings were derived from the selected studies using a thematic and comparative analysis.
Results: The scoping review revealed the lack of standard definition for EHR data elements as they are transformed into input modalities. These definitions ignore one or more key characteristics of the data including source, encoding scheme, and concept level. Moreover, in order to adapt to emergent generative learning techniques, the classification of fusion architectures should distinguish fusion from learning and take into consideration that learning can concurrently happen in all three layers of new fusion architectures (i.e., encoding, representation, and decision). These aspects constitute the first step towards a streamlined approach to the design of multi-modal fusion architectures for routine care EHR data. In addition, current pretrained encoding models are inconsistent in their handling of temporal and semantic information thereby hindering their re-use for different applications and clinical settings.
Conclusions: Current routine care EHR fusion architectures mostly follow a design-by-example methodology. Guidelines are needed for the design of efficient multi-modal models for a broad range of healthcare applications. In addition to promoting re-use, these guidelines need to outline best practices for combining multiple modalities while leveraging transfer learning and co-learning as well as semantic and temporal encoding
Neurocognitive manifestation after treatment of pediatric severe anaphylaxis
No full textBackground: Anaphylaxis is a common, severe, and life-threatening allergic reaction that occurs rapidly after exposure to an allergen which can affect multiple systems in the body. In rare cases, it may lead to additional neurological manifestations that are poorly understood.
Case presentation: We present a case of a 14-year-old boy who experienced severe anaphylaxis necessitating airway intervention and admission to critical care. While his initial presentation and treatment aligned with current standards, he subsequently developed prolonged neurological deficits, including weakness, prosopagnosia, amnesia, and loss of basic functions, during an extended recovery period.
Conclusion: This rare neurological manifestation following anaphylaxis may be overlooked by many clinicians. Therefore, it is imperative to highlight this potential complication to improve the management of patients experiencing anaphylaxis
RABEP1 amplifies front signaling in neutrophil migration
No full textNeutrophils are the first responders of our innate immune system, crucial for defense against various infections. The intricate regulation of neutrophil migration is essential for neutrophil function. However, a complete mechanistic understanding is missing. We performed a miRNA overexpression screen and identified miR-190 as a potent suppressor of neutrophil migration in zebrafish. Through a second round of small-scale screening using neutrophil-specific knockouts of putative miR-190 targets, we identified that rabep1 (Rabaptin-5, RAB GTPase binding effector protein 1) is essential for neutrophil motility and chemotaxis in zebrafish. Re-expressing full-length RABEP1 in the knockout, but not a truncated form lacking the Rab4/Rab5 binding domain, rescued cell motility. Knocking down RABEP1 in human dHL-60 cells consistently reduced cell motility. RABEP1-deficient dHL-60 cells accumulate excessive members inside the cells. The Rab5 GTP level is unaffected, but the RABEP1 knockdown cells displayed reduced PAK phosphorylation and overall reduced actin polymerization, but still appropriately polarized upon chemokine stimulation. Overexpression of dominant-negative Rab4 or Rab5 similarly inhibits neutrophil migration. Our data suggests that RABEP1 drives endosomal recycling, Rac activation, and leading-edge actin polymerization, providing significant insights into the role of the endocytic pathway in neutrophil motility
Carpometacarpal Arthrodesis for Spasticity-Related Thumb-in-Palm Deformity
No full textIntroduction: Patients who suffer from upper motor neuron (UMN) disease frequently develop a thumb-in-palm (TIP) deformity, wherein the thumb metacarpal is adducted, severely limiting function and potentially causing compromised hand hygiene. The role of surgical treatment in this population ranges from tendon transfers, soft tissue releases, and in severe cases, arthrodesis. In this study, we review our experience with carpometacarpal (CMC) arthrodesis with staples for the treatment of UMN related recurrent TIP deformity.
Methods: This single surgeon case series included 5 patients with UMN-related TIP deformity who underwent CMC arthrodesis with nitinol staples. Data regarding union, infection, hardware failure, and recurrence of TIP deformity were recorded from the electronic medical record.
Results: All patients achieved radiographic union. The average follow-up was 2.7 months. No patients had evidence of recurrence of TIP deformity, hardware loosening, infection, dehiscence or delayed healing.
Conclusion: This is the first described use of thumb CMC arthrodesis using nitinol staples in patients with UMN-related recurrent TIP deformity. The use of staples for CMC arthrodesis in the UMN population is an effective method without evidence of failure or recurrence
