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Infection Risk Associated with Left Ventricular Assist Device Implantation and Diabetes Mellitus: An Integrative Review
Get PDFBackground and Purpose: A left ventricular assist device (LVAD) is a surgically implanted mechanical pump used in the treatment of heart failure, with approximately 2,500 implantations occurring annually the United Staes. Diabetes mellitus, a common comorbidity of heart failure, slow wound healing and immune response. LVAD implantation requires open heart surgery and includes a driveline on the exterior of the body, increasing the risk of infection. This review aims to analyze evidence-based practices focused on preventing LVAD-related infections in diabetic patients.
Methods: An integrative review was conducted following the PRISMA framework and using PubMed, CINAHL, and Scopus.
Results: Fifteen studies were included in this review. The thematic analysis identified risks of developing an infection, mortality, or other complications from driveline implantation. However, findings were inconsistent identifying diabetes mellitus as a significant risk factor for developing infection, mortality, or other complications in LVAD patients. Notably, none of the studies addressed evidence-based infection prevention practices and their comparison to standard care.
Conclusion: This review found inconclusive evidence on the impact of diabetes mellitus on infection risk, mortality, and complications in LVAD patients. It also highlights a critical gap in the literature regarding standardized infection prevention protocols for this population, underscoring the need for further research.Bachelor of Scienc
Initial development of the Stress Monitoring and Response Tool (SMART): A holistic measure of stress following trauma
Get PDFIn the immediate aftermath of trauma exposure, individuals may experience an acute stress reaction (ASR). ASRs may be transient but for individuals operating in high-stakes occupations, these reactions can potentially endanger themselves and those around them. Thus, a better understanding of ASRs could facilitate development of early interventions that help prevent longer-term sequelae. Although existing measures (e.g., PCL-5, CAPS-5) target symptoms that occur in the weeks following trauma, they do not encompass the range of ASR symptoms identified in emerging research. Using data from a large-scale study conducted across emergency departments in the United States, we employed confirmatory factor analysis to identify survey items that sensitively assess ASR symptoms during the peri- and post-trauma phases. These analyses identified 23 core items that are appropriate for administration both immediately following trauma exposure and at later timepoints, as well as 11 supplementary items that can be added to the core items for assessment at later timepoints. Collectively, these items constitute the Stress Monitoring and Response Tool (SMART). Both the SMART Core Scale and the combined SMART Core Scale with Supplemental Items demonstrate good convergent and concurrent validity with several other measures of mental health, physical health, somatic symptoms, pain, and functioning. In addition, the SMART scale remains moderately-to-strongly correlated with multiple measures of symptoms and functional impairment at three months post-trauma. Consequently, the SMART can be used to assess individuals in clinical settings, predict trajectories of recovery, and inform tailoring of interventions across time. Future studies should be conducted to assess the potential utility of the SMART as a decision aid in high-intensity occupational contexts
Effects of internal migration on healthcare services utilization in Bangladesh: an analysis of nationally representative survey
Get PDFDespite the significance of internal migration as an important social determinant of health that could potentially affect the utilization of maternal healthcare services, the magnitude of this relationship by different migration streams is yet to be fully explored in Bangladesh. This study using Bangladesh Demographic and Health Survey data, 2017–18 examined the effects of different migration streams on maternal healthcare service utilization, particularly four or more antenatal care (≥4 ANC) visits and institutional delivery (ID) care services. The analysis identified significant variations in using antenatal and institutional delivery care services between migrants and non-migrants. The rural non-migrants were found to be the most disadvantaged group, particularly when different forms of migration streams were considered. For instance, after adjusting for covariates, urban to urban migrants (≥4 ANC = 1.866, p < 0.01; ID = 2.247, p < 0.001) and urban to rural migrants (≥ 4 ANC = 1.24, p > 0.05; ID = 1.689, p < 0.05) were more likely to utilize both types of maternal healthcare services than rural non-migrants. However, migrants of all streams were less likely to use any type of maternal healthcare services when compared against the urban non-migrants. Addressing the effects of migration in designing and implementing maternal healthcare service delivery programs may address the needs and challenges faced by migrants
Exploring Strategies to Promote Exercise as a Viable Obesity and Chronic Disease Treatment
Get PDFObesity and its related comorbidities continue to be a primary public health concern, especially in the United States (US). Such comorbidities include the top two causes of death in the US: cardiovascular disease and cancer. Obesity is also associated with several other chronic conditions that affect millions of adults and children, including diabetes, kidney, and liver disease. Weight loss has long been considered the front-line treatment and prevention strategy for these conditions. Lifestyle approaches, including dietary modification and increasing physical activity, are typically recommended for individuals with obesity, although rates of achieving and maintaining clinically meaningful weight loss remain low. Understanding the root causes of minimal weight loss and weight regain has been a prime focus among many researchers over the past several decades. The present review addresses several advantages of prioritizing exercise as an obesity and chronic disease treatment. We discuss current challenges when exercise is the primary treatment strategy, including physiological parameters that may influence the efficacy of exercise in addition to behavioral and environmental factors that play a role in exercise adherence and adoption. We also explore strategies and principles that, although not commonly utilized in an obesity/chronic disease treatment setting, may be applied and adapted to fit this model
Refining breast cancer genetic risk and biology through multi-ancestry fine-mapping analyses of 192 risk regions
Get PDFGenome-wide association studies have identified approximately 200 genetic risk loci for breast cancer, but the causal variants and target genes are mostly unknown. We sought to fine-map all known breast cancer risk loci using genome-wide association study data from 172,737 female breast cancer cases and 242,009 controls of African, Asian and European ancestry. We identified 332 independent association signals for breast cancer risk, including 131 signals not reported previously, and for 50 of them, we narrowed the credible causal variants down to a single variant. Analyses integrating functional genomics data identified 195 putative susceptibility genes, enriched in PI3K/AKT, TNF/NF-κB, p53 and Wnt/β-catenin pathways. Single-cell RNA sequencing or in vitro experiment data provided additional functional evidence for 105 genes. Our study uncovered large numbers of association signals and candidate susceptibility genes for breast cancer, uncovered breast cancer genetics and biology, and supported the value of including multi-ancestry data in fine-mapping analyses
Characterizing timber harvest occurrence and intensity to inform forest carbon management across the eastern United States
Get PDFTimber harvesting plays an important role in determining how forest management practices influence carbon storage and sequestration patterns. We analyzed recent harvesting patterns across the eastern United States to quantify harvest area, intensity, and type of silviculture across timberlands. We observed timberland area harvested to vary considerably depending on how harvest occurrence was defined, ranging from 7.8 to 23.4 million hectares harvested between approximately 2016 and 2022. Harvest intensity, as measured by basal area removed in a stand if a harvest occurred, was similar across all ownerships, states, and regions (mean percent of basal area removed was 44.2 ± 29.3% [mean ± standard deviation]), but forest type-level differences were apparent, e.g., harvest intensity was greatest in aspen/birch forests in the Lake States (mean percent of basal area removed of 59.1 ± 31.2%). Policymakers, forest managers, and carbon project developers require an accurate assessment of baseline harvest rates to estimate potential tonnes of additional carbon dioxide equivalents generated in a forest carbon offset project. Using localized timber harvesting patterns derived from historical data will assist in prioritizing the silvicultural prescriptions with the greatest positive climate impacts while additionally informing policies and investments that value the natural capital that forests provide
Assisted partner notification as a strategy to enhance Pre-Exposure Prophylaxis (PrEP) screening and uptake – results from a prospective cohort study in Lilongwe, Malawi
Get PDFBackground Pre-exposure prophylaxis (PrEP) prevents HIV acquisition but strategies are needed to improve uptake among high-risk groups. Assisted partner notification (aPN), proven for HIV case-finding, may expand PrEP services to sexual partners of sexually transmitted infection (STI) patients. While passive (index-led) partner notification for STI treatment receipt is standard, offering an assisted strategy may increase linkage to PrEP for HIV vulnerable partners who may otherwise be missed. This study explored the feasibility and outcomes of integrating aPN into PrEP programs at an STI clinic in Malawi. Methods Between March 2022 and January 2023, this prospective cohort study enrolled men and women presenting for STI services who were initiating PrEP (index PrEP user) and their referred sexual partners. Using World Health Organization-recommended aPN methods, recent (within last 6 months) sexual partners named by index participants were traced via phone or in-person. We assessed demographic characteristics of index participants and referred partners, tracing outcomes, and PrEP initiation among partners. Results 174 index PrEP user participants were enrolled, most were male (109/174; 63%) with median age of 27 years (IQR 22, 32). The 174 index participants were asked to provide contact information for their partners, 69 of whom did. These 69 participants named 101 sexual partners (57% female). Partners were named as primary partners (53%), casual partners (41%), or sex workers (6%). Tracing efforts were employed for 52 partners with phone tracing yielding a 57% contact success and physical tracing yielding a 10% contact success. 58 partners (including those not traced) presented at the clinic for screening. Most presenting partners were female (39/58; 67%) and the median age was 28 years (IQR 23, 31). Among the presenting partners, 34/58 were eligible for PrEP, and 31/34 (91%) initiated PrEP. 20 of 55 named partners who agreed to testing were HIV positive, with 20% of these newly diagnosed during PrEP screening. Conclusions aPN, including passive notification, effectively identifies and links at-risk partners of persons initiating PrEP to HIV prevention services, achieving high rates of PrEP uptake among eligible presenting partners, though less than half of index PrEP users named partners for tracing. Notably, phone tracing was more effective than physical tracing, but phone number availability was limited. This study highlights the potential of aPN in expanding PrEP access and strengthening HIV prevention efforts among persons seeking STI services.Trial registrationThis trial is registered on 5 October, 2023 at ClinicalTrials.gov NCT05307991
US young adults, April-June 2024
Get PDFLoneliness is high among young adults in the US, which leads to unique health risks among young adults with lower subjective social status. We aimed to optimize evidence-based intervention messages as video social media posts to encourage in-person social interactions
Celebrity Endorsements And Inducements In Sports Betting Advertising: A Mixed-Methods Analysis Of NFL Marketing Practices And Its Impact On Consumer Trust And Risk Perception
Get PDFThis study investigates sports betting advertising strategies and their impact on college students following the 2018 legalization wave. Content analysis of NFL broadcasts revealed ubiquitous celebrity endorsements and promotional inducements, with minimal visibility of responsible gambling information. Survey results from 224 college students demonstrated that celebrity appearances significantly enhanced betting operators' perceived trustworthiness and reduced risk perception, outperforming monetary inducements in effectiveness. Athletes and sports personalities generated particularly strong trust effects. Responsible gambling messages went largely unnoticed, creating a concerning asymmetry between promotional and protective elements. These findings suggest that parasocial relationships with celebrities may be more influential than financial incentives in shaping how young adults evaluate betting operators and gambling risks, with important implications for regulatory approaches and consumer protection strategies.Master of Art
Establishment of a neonatal resuscitation registry in the Democratic Republic of the Congo: An open cohort study
Get PDFImproving neonatal resuscitation practices reduces neonatal mortality. In low- and middle-income countries (LMICs), granular details about provider actions during resuscitation are largely unknown; therefore, identifying targets for improvement is difficult. The International Liaison Committee on Resuscitation (ILCOR) recognizes the importance of uniform reporting of clinical neonatal resuscitation studies and published a guideline recommending specific variables to include. We established an open cohort study for newborn resuscitation in the Democratic Republic of the Congo (DRC) as a platform for developing and evaluating novel strategies to improve newborn resuscitation. We included all in-born neonates at two health facilities in Kinshasa, DRC. We gathered data on all enrollees via delivery registry and medical record abstraction. Using the Liveborn Observation app, we directly observed care at birth for a convenience sample. We collected heart rate data when providers used NeoBeat, a battery-operated heart rate meter. From September 2022 to August 2023, we abstracted delivery registry and medical record data for 6,414 newborns and gathered observational data on the infant’s breathing status and provider actions for 3,166 (49%). Our dataset includes 85% of ILCOR’s recommended core variables applicable to this setting, and 50% of ILCOR’s applicable supplemental variables. Our registry also contains variables beyond those recommended by ILCOR that are contextually important for evaluating resuscitation care in LMICs such as duration of suctioning, pauses in positive pressure ventilation and fresh stillbirth. Our experience establishing a resuscitation registry with novel tools in the DRC serves as a model for resuscitation research in low-resource settings. Our cohort study provides important insight to inform subsequent versions of ILCOR’s guideline on uniform reporting of neonatal resuscitations studies globally