19043 research outputs found
Sort by
Monitoring Cortical Spreading Depolarization: Advancements and Applications in Neurocritical Care: A Scoping Review
No full textCortical spreading depolarization (CSD) describes a slow, sustained depolarization within the cerebral gray matter that renders neurons unable to fire action potentials, resulting in widespread neuronal depression. CSD has been observed in stroke, subarachnoid hemorrhage, epilepsy, traumatic brain injury, and migraines and is a potential indicator of imminent neuronal death. Therefore, the identification, monitoring, and treatment of CSD are crucial in both neurointensive care and neurosurgical settings. Such measures are paramount for optimizing outcomes among patients with neurological injuries. However, this slow-spreading depolarization at high amplitudes presents challenges to identifying and monitoring CSD in clinical settings. We aim to identify various current and potential techniques for monitoring CSD in neurocritical care and neurosurgical settings, alongside exploring available treatment modalities. We also analyze current limitations in the detection of CSD, including the identification of potential biomarkers. A brief comprehensive scoping review of available literature utilizing search engines such as PubMed and Google Scholar was conducted using key search terms such as “cortical spreading depression”, “CSD”, “spreading depolarization”, and “CSD monitoring”. Eligibility for this review was restricted to full-text, English, peer-reviewed literature articles. There were no restrictions on publication dates. Around 450 articles discussing CSD were reviewed and ultimately 65 articles were included in the analysis. Electrocorticography (ECoG), an invasive modality that involves placing electrodes on the brain tissue directly, remains the primary modality to detect CSD, both in the neurosciences intensive care unit (NSICU) and during neurosurgical procedures. However, there are other potential modalities for detection such as Electroencephalogram (EEG), pressure reactivity index (PRx), magnetoencephalography (MEG), MRI/fMRI, and laser speckle imaging (LSI). These methods have been tested in animal models and/or in clinical practice but each has drawbacks that render these modalities not readily available or nonfunctional as independent detection methods in the NSICU. Nevertheless, a multimodal monitoring approach utilizing a combination of monitoring modalities such as ECoG in conjunction with tools that measure cerebral vascular response such as cerebral perfusion pressure, cerebral blood flow, and PRx could provide timely measurements of CSD. There are potential biomarkers being studied for early detection of CSD which include adenosine, GFAP, lactate, IL-6, or TNF-alpha. Some treatment modalities that have been studied that inhibit or halt CSD include: topiramate, valproate, propranolol, amitriptyline, methysergide, Propofol, and glutamate receptor inhibitors. Although several methods have been studied, invasive ECoG remains the gold standard for CSD detection. There are currently no reliable non-invasive modalities for CSD detection. Nevertheless, a multimodal approach that utilizes ECoG in conjunction with different methods of monitoring, could prove a useful tool in NSICU as well as neurosurgical procedures. Further research is needed to not only determine the utility and application of other monitoring methods in the clinical setting but also explore non-invasive monitoring methods
Communication Interventions to Reduce Parental Vaccine Hesitancy: A Systematic Review
No full textIntroduction: Vaccine hesitancy among parents and caregivers is a growing issue that can lead to reduced vaccine coverage and corresponding outbreaks of disease. Different interventions to reduce vaccine hesitancy have been developed, including the use of remote online communication that has become more common during the COVID-19 pandemic, but their impacts and effectiveness are unclear. In this systematic review, we aimed to identify effective types of communication that reduce vaccine hesitancy. Methods: Multiple online databases were searched on April 1st, 2022 as well as March 18th, 2024. Included articles studied the impact of communication interventions aiming to reduce vaccine hesitancy among parents and caregivers of young children. Interventions targeting adolescent or adult vaccines were excluded. Potential biases or limitations that may affect the results of each study were evaluated. Results: Out of 3873 identified articles, 33 studies were included in this review, and 25 showed effectiveness. Among the 25 effective communication interventions, 11 were in-person and interactive, 11 were neither in-person nor interactive, 3 were interactive but not in-person, and 2 were in-person but not interactive. Discussion: Communication interventions can reduce vaccine hesitancy and increase childhood vaccine coverage. Although different types of interventions can reduce vaccine hesitancy and increase childhood vaccine coverage, especially by in-person and interactive communication interventions, further research is needed to elucidate the components that make such interventions impactful in different settings. These findings are particularly relevant for clinicians and public health officials striving to reduce vaccine hesitancy and increase vaccine uptake among children
Uninsured Status Is Associated With Worse Outcomes in a Cohort of Pediatric Patients With Traumatic Brain Injury
No full textBackground: Pediatric traumatic brain injury (pTBI) is a leading cause of morbidity and mortality in children. In this study, we sought to investigate the impact of insurance status on pTBI outcomes using a single-center registry. Methods: A retrospective study was conducted of pTBI patients at a Level I Pediatric Trauma Center from January 2012 to July 2023. Patients were stratified by insurance status (private, public, uninsured) and transfer status. Results: Of 359 patients, 49 % had private insurance, 46 % public, and 5 % were uninsured. Uninsured patients had higher injury severity score (ISS), longer length of stay (LOS), and higher mortality (27.8 % vs. 2.3 % private, 0.6 % public) (p \u3c 0.01). After adjusting for injury severity, uninsured status was a significant predictor of mortality (OR, 19.315) and prolonged LOS (OR, 5.552). Conclusions: Uninsured pTBI patients experience worse outcomes, including longer hospital stays and increased mortality. Addressing healthcare disparities through targeted interventions and policy changes is essential to improve outcomes for uninsured pTBI patients
Social and Racial Disparity Impacts Victims of Physical Abuse Among Trauma Patients
No full textBackground: Violence in the form of physical abuse is an underreported crime and a significant social problem in the United States. However, the true burden of the problem as well as the predictors of intervention remain unknown. The aim of our study was to assess the prevalence of physical abuse among trauma patients, and to identify the predictors of investigation of physical abuse by law enforcement and change in caregiver on discharge. Methods: A 3-y (2017-2019) retrospective analysis of the Trauma Quality Improvement Program database was performed, which included a total of 3,138,896 trauma patients. Trauma patients who had reported physical abuse were identified. Patients were stratified by age into the following 3 groups: pediatric (\u3c18 y), adults (18-65 y), and geriatric patients (\u3e65 y). We also performed multivariate logistic regression analysis to examine the effects of different patient characteristics on the likelihood of change in caregiver and investigation. Results: A total of 26,043 patients were identified who had reported physical abuse of which 44.1% (n = 11,490) were pediatric, 49.9% (n = 13,001) were adults, and 6% (n = 1552) were geriatric. Among different age groups, reported physical abuse was higher in American Indians, Blacks, Pacific Islanders, Asians, and Whites, respectively. Male gender (odds ratio [OR] = 1.706, 95% confidence interval [CI; 1.706-1.566]), Black race (OR = 1.222, 95% CI [1.111-1.346]) and injury severity score (OR = 1.005, CI 95% [1.001-1.010]) were the predictors for change of a caregiver at the time of discharge. Evaluation of predictors for initiating an investigation enforcement showed that Black race (OR = 2.55, 95% CI [1.94-3.35]) was strongest. Conclusions: Among trauma patients, racial disparity exists in reporting, investigating, and changing of the caregiver in cases with reported physical abuse. Further studies are warranted to identify possible underlying causes of disparities in reporting, investigation, and intervention for victims of abuse
Early Initiation of SGLT2 Inhibitors in Acute Myocardial Infarction and Cardiovascular Outcomes, an Updated Systematic Review and Meta-Analysis
No full textBackground: Sodium-glucose cotransporter-2 (SGLT2) inhibitors increase survival rate in heart failure, but early initiation of these agents after acute myocardial infarction (MI) is controversial. Methods: We searched PubMed, Scopus, Embase, and ClinicalTrial.gov for randomized clinical trials (RCTs) and propensity score matched (PSM) cohort studies up to September 29,2024. Eligible studies of patients with acute MI that were assigned to either SGLT2 inhibitors or placebo were enrolled in final meta-analysis. The primary endpoint was heart failure hospitalization (HHF). Secondary endpoints were: all-cause mortality, stroke, cardiovascular mortality, stroke and composite of major adverse cardiovascular events (MACE).We conducted frequentist and Bayesian meta-analyses. Results: we identified ten studies (7 RCTs and 3 PSMs) with 15,133 patients. Frequentist meta-analysis showed that SGLT2 inhibitors significantly reduced HHF [RR:0.67 (0.47–0.95); I2: 57%], and MACE significantly decreased in the SGLT2 inhibitor group [RR:0.77 (0.60–0.98); I2: 46%]. Bayesian meta-analysis for HHF suggested a non-significant reduction [RR: 0.8 (95% CrI: 0.4–1.4)]. No significant reduction was observed in SGLT2 inhibitors group regarding all-cause mortality, cardiovascular mortality, non-fatal MI and stroke. Conclusion: Early initiation of SGLT2 inhibitors in acute MI was associated with reduced risk of HHF, though Bayesian analysis indicates uncertainty. MACE risk significantly reduced and no significant impact was observed on all-cause mortality, CV mortality, non-fatal MI and stroke
Non-Alcoholic Fatty Liver Disease versus Cirrhosis in Rotator Cuff Repair: Differential Risks and Complication Profiles in a Matched National Cohort
No full textIntroduction: As obesity rates continue to rise in the United States, orthopedic surgeons are increasingly encountering its metabolic sequelae, including non-alcoholic fatty liver disease (NAFLD), in surgical populations. NAFLD has emerged as the most common chronic liver condition, with rising prevalence mirroring trends in obesity and metabolic syndrome. Despite this, the orthopedic implications of NAFLD remain underrecognized. While the effects of advanced liver disease on surgical outcomes are better established, direct comparisons between NAFLD and cirrhosis in the context of rotator cuff repair (RCR) remain limited. Methods: A retrospective cohort analysis was conducted using the Mariner M170Ortho database Adults undergoing primary RCR between 2010 and 2020 were identified using CPT codes 23410 and 23412. NAFLD and non-alcoholic cirrhosis were defined by ICD-9 and ICD-10 codes. From an initial cohort of 241,571 RCR cases, 1360 patients with cirrhosis and 3246 with NAFLD were identified. After 1:1 propensity score matching on age, sex, Charlson Comorbidity Index (CCI), obesity, tobacco use, and alcohol-related diagnoses, two well-balanced cohorts of 692 patients each were analyzed. Multivariable logistic regression was used to evaluate 90-day complications, adjusted for age, sex, and CCI. Results: Most 90-day complication rates were comparable between groups. However, patients with NAFLD had significantly lower odds of hospital readmission (1.6 % vs 2.9 %; OR 0.34, 95 % CI 0.11–0.85; p = 0.032) and overall postoperative complications (7.8 % vs 10.4 %; OR 0.54, 95 % CI 0.34–0.83; p = 0.006) compared to those with cirrhosis. No significant differences were observed in infection, thromboembolism, renal complications, or mortality. Conclusion: In patients undergoing rotator cuff repair, the presence of NAFLD was associated with a reduced risk of postoperative complications and readmission compared to non-alcoholic cirrhosis. These findings underscore the importance of liver disease severity in orthopedic risk stratification and perioperative planning
Remote Work, Well-Being, and Healthy Labor Force Participation Among Older Adults: A Scoping Review
No full textBackground: Aging populations make expanded workforce participation among older adults an economic and public health priority. The COVID-19 pandemic accelerated the growth of virtual work, providing new opportunities for healthy aging in the workplace through increased flexibility and less physical strain. However, digital exclusion, ergonomically challenging tasks, and social isolation can limit these opportunities for older populations. Objective: This scoping review aimed to synthesize interdisciplinary research on the relationship between remote work and labor force participation among adults aged 45 years and older, focusing on health-related outcomes, barriers, and facilitators. Methods: Following the JBI Manual for Evidence Synthesis and PRISMA-ScR guidelines, we conducted a comprehensive search across seven databases for peer-reviewed and gray literature published between 2000 and 2025. Of 2108 records screened, 33 studies met the inclusion criteria. Data were extracted using a standardized charting tool and analyzed thematically. Results: Most studies were published after 2020 and originated in North America (45%) and Europe (40%). Core barriers included digital exclusion, ageism, and adverse ergonomic environments. Facilitators involved flexible working hours, a supportive organizational environment, and digital skills. Health-related outcomes such as stress reduction and improved well-being were commonly reported. However, only 18% of studies assessed policy effects, and very few examined intersectionality (e.g., gender, socioeconomic status). Conclusions: Remote and flexible work options can improve the health and participation of older adults in the workforce, but technology, infrastructure, and social barriers remain. Age-inclusive policies, digital equity efforts, and inclusive workplace practices are necessary to maximize the benefits of remote arrangements for aging populations
Constitutional Freedoms in the United States
Get PDF2025
Constitutional Freedoms is an undergraduate text for courses in civil rights and liberties. It covers most of the subject areas of other undergraduate texts, although it rearranges some in ways that are more conducive to student learning. The major difference is that freedoms of speech and press are treated together as aspects of communication, rather than separately because so distinguished in the US Constitution. The book includes sections on Supreme Court procedure, methods of interpretation, and tests for unconstitutionality, as well as information about experiential learning opportunities for students.https://touroscholar.touro.edu/opentextbooks/1008/thumbnail.jp
