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Group-based telehealth stress management-lifestyle interventions are feasible for patients with chronic liver disease.
Get PDFGroup-based, telehealth behavioral interventions may be efficient, effective, and acceptable treatment modalities for patients with chronic liver diseases; however, pilot feasibility and patient satisfaction data are needed to justify efficacy trials. Given the poor quality of life, symptoms, and health risk factors, patients with chronic hepatitis C-associated liver disease (HCV-LD) may benefit from psychosocial interventions. A pilot feasibility study of a videoconferencing-delivered cognitive behavioral coping skills intervention ("VC-CBCS") was conducted to evaluate multiple indicators of feasibility, levels of patient satisfaction, and changes in patient-reported outcomes (PROs).We pilot tested a 14-week, 90-minute VC-CBCS intervention by conducting a small randomized controlled trial. Thirty-two adults with HCV-LD and high stress/symptom levels were randomized to the protocolized VC-CBCS intervention (n=24) or standard of care (n=8), in 4 waves of 7-9 participants in 2020-2021.Based upon rates of approach to enrollment (60%), retention (84%), PRO data collection (99.4%), and session attendance (91%), a future efficacy trial appears highly feasible. Levels of participant satisfaction were encouraging for VC delivery, intervention content and structure, and group processes. Technological and behavioral issues were minor. Collection of in-home saliva testing was not feasible. Moderate to large pre-post-intervention effect sizes were observed for some mediators (perceived stress, coping, relaxation, self-efficacy, sleep hygiene), with some of these changes correlating with small to moderate improvements in mental health and symptoms (eg, depression, fatigue; effect size range: 0.23-0.47). No consistent patterns were evident between changes in eating and exercise behaviors and PROs.A group-based VC-CBCS intervention appears feasible and may address unmet psychosocial needs in patients living with chronic liver disease
Cognitive Offloading and Autonomous Agency: A Comprehensive Review of Self-Regulating Smartphone Architectures
Get PDFA specific, stable, and accessible LAMP assay targeting the HSP70 gene of Trypanosoma cruzi.
Get PDFDiagnostic delays prevent most Chagas disease patients from receiving timely therapy during the acute phase when treatment is effective. Quantitative PCR (qPCR)-based diagnostic methods provide high sensitivity during this phase but require specialized equipment and complex protocols. More simple and cost-effective tools are urgently needed to expand early Chagas disease diagnosis in low-income endemic regions. Here, we present a loop-mediated isothermal amplification (LAMP) that targets a highly conserved region in the HSP70 gene of Trypanosoma cruzi, the causative agent of Chagas disease. This assay demonstrates species-specific amplification across multiple parasite genetic lineages while maintaining stability after 1 hour of incubation and at least 8 months of storage at -20°C. Moreover, the assay is at least 12 times less expensive than the TaqMan qPCR that is currently routinely used for acute Chagas diagnostics and is compatible with a low-cost CTAB-based DNA extraction method. Population-based validation in 100 infants born to Chagas-positive mothers in Santa Cruz, Bolivia, yielded a specificity of 100% and sensitivity exceeding 77% when compared to a TaqMan qPCR that targets satellite DNA. This cost-effective DNA extraction method and LAMP assay demonstrate potential for diagnosing Chagas disease in resource-limited endemic regions, particularly where qPCR is unavailable. IMPORTANCE: Chagas disease, caused by the parasite Trypanosoma cruzi, is a life-threatening illness that disproportionately affects resource-limited communities. Congenital Chagas disease, if diagnosed early, presents a unique opportunity for intervention, as treatment in newborns is highly effective with minimal side effects. However, early diagnosis is hindered by the high cost and limited availability of current molecular diagnostic methods in endemic regions. Our study introduces a simple, low-cost, and highly specific LAMP assay targeting the HSP70 gene of T. cruzi. This assay is user-friendly, stable under varying storage and incubation conditions, and designed for accessibility in underserved areas. By providing a detailed, open-access protocol and primers, we aim to facilitate the widespread adoption of this diagnostic assay, enabling earlier detection and treatment. This assay lays the groundwork for a new approach to Chagas disease management, potentially reducing the spread of Chagas disease and improving public health outcomes in vulnerable populations globally
The associations of premorbid social isolation and social support with self-rated health and heart failure outcomes in the atherosclerosis risk in communities (ARIC) Study
Get PDFWe assessed whether social isolation (SI), social support (SS), and subtypes of SS were associated with self-rated health trajectories and clinical heart failure (HF) outcomes among participants with incident HF hospitalizations. We included 2967 Atherosclerosis Risk in Communities study participants with incident HF hospitalization after Visit 2 (1990–1992). SI, SS, and subtypes of SS were measured at Visit 2. We identified incident HF hospitalization as ICD-9 code 428 and physician adjudicated events; on average HF occurred 17 (SD 8) years after Visit 2. We assessed associations with trajectories of annually measured self-rated health in the 4 years prior to and after incident HF hospitalization (excellent/good self-rated health on a 0–100 scale), using linear mixed effects models. We calculated hazard ratios (HR) and 95% confidence intervals (CIs) for associations with time to first all-cause rehospitalization and all-cause mortality using Cox proportional hazard models. Low overall SS had a 5.8 point (95% CI 7.8, 3.8) lower self-rated health value over time than high SS; associations of subtypes of SS with this outcome were similar. Low belonging SS was associated with greater days to first rehospitalization (HR 0.85; 95% CI 0.79, 0.96) compared to the highest tertile; however, belonging SS was not associated with mortality (HR 1.05; 95% CI 0.95, 1.17). Being socially isolated/high risk for SI was associated with greater hazard of all-cause mortality among females (HR 1.57; 95% CI 1.20, 2.06) but not males (HR 0.95; 95% CI 0.75, 1.19), compared to low SI. SI and SS were not associated with number of hospitalizations in the first year or percent of first year spent at home
Prenatal Organophosphate Pesticide Exposure and Targeted Maternal Pregnancy Metabolomic Profiles in the NYU CHES Cohort
Get PDFPrior research links prenatal exposure to organophosphate (OP) pesticides to adverse health outcomes via molecular mechanisms, such as oxidative stress, neurotransmitter disruption, and mitochondrial dysfunction. This study investigates such mechanisms by assessing the relationships between prenatal OP pesticide exposure and targeted urinary maternal metabolomic profiles using data from the New York University Children's Health and Environment Study (NYU CHES) cohort (n = 890). Urine samples were collected at three time points during pregnancy (T1, T2, T3) and analyzed for six dialkyl phosphate (DAP) metabolites and a targeted set of 188 metabolites related to key biological functions. Associations between DAP concentrations and individual metabolites were estimated using linear and logistic regression models, with adjustment for potential confounders. Statistical analysis revealed significant associations between OP exposure and the studied maternal metabolomic profile, with the most associations observed during late pregnancy (T3). The most robust associations across all models and time points were observed for acylcarnitine profiles, which were consistently altered in association with OP exposure. This study identifies specific metabolic signatures associated with OP pesticide exposure during pregnancy, providing insights into potential mechanisms of toxicity and implications for maternal and child health. Additional research is needed to validate these findings and further understand the functional significance of the identified metabolic disturbances
Identification and Biological Validation of MMP-12 Inhibitors Guided by Pharmacophore-Based Virtual Screening and Docking Studies
Get PDFMatrix metalloproteinase-12 (MMP-12) is a zinc-dependent enzyme involved in extracellular matrix remodeling and inflammatory processes. In this study, a ligand-and structure-based design approaches including pharmacophore modeling and molecular docking were employed to identify potent MMP-12 inhibitors. Indole-3-acetic acid derivatives were prioritized based on their fit to a pharmacophore model and strong predicted interactions within the MMP-12 catalytic site. Selected compounds were synthesized and evaluated using a colorimetric enzyme inhibition assay. Docking studies revealed favorable binding energies and key interactions with active-site residues such as HIS-218, PHE-237, GLU-219, and LEU-181. Enzyme inhibition assays validated the activity of the indole-3-acetic acid scaffold, with four leading candidates (C23–C26) demonstrating over 94% inhibition of MMP-12. The integration of in silico predictions with experimental testing guided the identification of indole-3-acetic acid as a promising scaffold, underscoring the utility of this design approach for scaffold prioritization. These findings establish indole-3-acetic acid as a promising scaffold for further development of MMP-12 inhibitors and provide a foundation for future biological evaluation
Short-term performance of Symvess (acellular tissue engineered vessel-tyod) compared to external control data for autologous vein in treatment of extremity arterial injury
Get PDFTo evaluate the short-term clinical performance of Symvess (acellular tissue engineered vessel-tyod), formerly known as human acellular vessel, or HAV, compared with autologous vein for the treatment of extremity arterial injury. Subjects treated with acellular tissue engineered vessel (ATEV) from two clinical trials were propensity score-matched on a 1:2 basis to PROspective Observational Vascular Injury Trial (PROOVIT) registry subjects with the same injured artery and treated with autologous vein. Matching characteristics included age, sex, trauma type (penetrating vs blunt), injury severity score, mangled extremity severity score, concomitant fracture, shunt use, and ischemia duration>6 hours. Incidence of outcomes (primary/secondary patency, amputation, conduit infection, reintervention for thrombosis/stenosis, pseudoaneurysm, and death) was assessed by a generalized linear model. Outcomes were assessed at Day 30 (ATEV group) or during initial hospitalization (autologous group). ATEV subjects lacking suitable autologous vein (n=67) and PROOVIT subjects treated with autologous vein (n=134) suffered injuries to axillary, brachial, femoral, popliteal, and posterior tibial arteries. Subgroups were clinically similar; Injury Severity Score, Mangled Extremity Severity Score, and duration of follow-up (16 vs 30 days) were higher for the ATEV subgroup. Primary patency for the ATEV versus autologous group was 86.6% versus 91.8%, secondary patency: 91.0% versus 97.7%; amputation: 7.5% versus 8.2%; conduit infection: 1.5% versus 0%; reintervention for thrombosis or stenosis: 6.0% versus 8.2%; and death 4.5% versus 4.5%, respectively. No cases of pseudoaneurysm, true aneurysm, or significant differences between the ATEV and autologous groups for any outcome were observed. Short-term outcomes were similar between ATEV subjects without feasible autologous vein, and propensity score-matched autologous vein recipients from the PROOVIT registry. The ATEV may provide effective and safe revascularization in subjects with extremity arterial injury without feasible autologous vein. Level 3, Therapeutic/Care Managemen
Psychometric evaluation of the Yale-Brown Obsessive-Compulsive Scale in pregnant women
Get PDFPurpose Although many women experience obsessive-compulsive symptoms during the perinatal period, the Yale-Brown Obsessive Compulsive Scale (YBOCS) has not yet been psychometrically evaluated in this population. This study examined the internal consistency, convergent and divergent validity, and factor structure of the YBOCS among pregnant women. Methods 256 Women who were 20 to 24 weeks pregnant completed the clinician-administered YBOCS and Mini International Neuropsychiatric Interview (MINI) along with a series of self-report questionnaires including the Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS) and Obsessive-Compulsive Inventory-Revised (OCI-R). Results Internal consistency of the YBOCS was excellent, and there were strong inter-scale correlations between the YBOCS Total Score, YBOCS Obsessions and Compulsions Severity Scales. The YBOCS demonstrated good known-groups validity differentiating women with and without OCD. Convergent validity with the OCI-R was demonstrated while relations with divergent validity were more mixed. Conclusion The YBOCS possesses strong psychometric properties in pregnant women
Tubal Sterilization And Vasectomy Increased Among US Young Adults After The Dobbs Supreme Court Decision In 2022
Get PDFYoung adults’ access to contraception is shifting after the June 2022 United States Supreme Court Dobbs v. Jackson Women’s Health Organization decision. This concurrent mixed-methods study measured young adults’ use of and perceptions about tubal sterilization and vasectomy after the leaked Dobbs opinion in May 2022. Using national-level medical claims data from IQVIA, we conducted difference-in-differences analyses of tubal sterilizations and vasectomies by age and state policy; using open-text survey responses from national MyVoice surveys in 2022 and 2023, we thematically analyzed young adults’ perspectives. Tubal sterilization and vasectomy visits increased after May 2022 among participants ages 19–26. Difference-in-differences analyses found significant increases in tubal sterilization and vasectomy visits in states deemed likely to ban abortion. Survey responses highlight fear of loss of bodily autonomy and changes to pregnancy plans after Dobbs. Young adults increasingly obtained permanent contraception post-Dobbs, especially in states deemed likely to ban abortion, and they continue to face challenges to their bodily autonomy, whether they feel pressured to seek permanent contraception because of abortion policy restrictions or whether they desire permanent contraception but experience barriers obtaining it
An Intersectional Analysis of Behavioral Financial Hardship and Healthcare Utilization among LGBTQ+ Cancer Survivors
Get PDFBACKGROUND: lesbian, gay, bisexual, transgender, queer, or another non-heterosexual or cisgender identity (LGBTQ+) cancer survivors experience high financial hardship. However, structural drivers of inequities do not impact all LGBTQ+ individuals equally. Using All of Us data, we conducted an intersectional analysis of behavioral financial hardship among LGBTQ+ cancer survivors. METHODS: LGBTQ+ inequities in behavioral financial hardship (ie, cost-related foregone care, delayed care, and medication alterations) and non-cost-related delayed care were estimated using All of Us Data. Multivariable logit models were used to generate predicted probabilities, average marginal effects (AME), and 95% confidence intervals. Models were then used to estimate inequities when disaggregating LGBTQ+ status and combing LGBTQ+ status with age, race, ethnicity, and treatment status. RESULTS: This analysis included N = 36,217 cancer survivors (6.6%, n = 2,399 LGBTQ+). In multivariable models, LGBTQ+ identity was associated with higher probabilities of and significant AME for all types of behavioral financial hardship (foregone care 31.1% vs. 19.4%; delayed care 22.6% vs. 15.6%; medication alterations 19.2% vs. 11.9%) and non-cost delayed care (14.3% vs. 7.2%). Within the disaggregated analysis, cisgender bisexual and another/multiple orientation women and gender minority survivors had the highest predicted probabilities of all outcomes. In intersectional analyses, survivors who were aged 18-39 and LGBTQ+, Black and LGBTQ+, or Hispanic/Latine and LGBTQ+ had the highest predicted probabilities of all outcomes. CONCLUSIONS: LGBTQ+ cancer survivors experience significantly more behavioral financial hardship and non-cost-related delayed care then non-LGBTQ+ cancer survivors. Interventions at the individual, system, and policy level are needed to address LGBTQ+ inequities in financial hardship