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Last Light at Peekskill
No full textA late autumn afternoon finds the southbound Amtrak Lake Shore Limited train approaching the town of Peekskill, NY, as birds play along the water and the fiery colors of fall shimmer in the breeze blowing off the Hudson River. // Fall 202
Winter Glory from the Bear Mountain Bridge
No full textThe shadow of the Bear Mountain Bridge is visible to the left of the frame as a southbound CSX intermodal train crosses the trestle where Popolopen Creek empties into the Hudson River, following a fresh overnight snowfall that blanketed the hills. // Winter 202
Friend and Foe: TGF-beta, Its Role in Tumor Development, and an Analysis of Chung et al. (2018)
No full textThis paper will analyze an important study performed by Chung et al. (2018) regarding transforming growth factor-beta (TGFbeta), which plays an important role in various cellular processes. Paradoxically, TGF-beta plays a different role in the development of cancer at various points. In early-stage tumors, TGF-beta has been known to inhibit cancer growth, but in later stages, it acts as a cancer promoter. Chung et al. (2018) attempted to ascertain the efficaciousness of the drug Sorafenib in suppressing TGF-beta responses, as well as the ways that this drug achieves its goal and the implications that their findings may have for future research. The present paper is divided into three parts. The “Introduction” will detail the history of the research on TGF-beta; “Results” will delve into Chung et al.’s (2018) experiment; “Conclusion” will outline the study’s implications and will suggest directions for further study. The paper concludes that while Chung et al.’s (2018) work lends hope to the fight against cancer, it is not yet sufficient to definitively state that TGF-beta’s mechanisms can be effectively exploited for therapies
Reply to Martin-Loeches and Rodriguez: Clinical Guidelines: Asking the Right Questions to Guide Fungal Infection Management
No full textDemographics, Management, and Outcomes Associated With Idiopathic Vocal Fold Paralysis: A Systematic Review
No full textObjective: Idiopathic vocal fold paralysis (IVFP) is an enigmatic disease that results in voice, breathing, and swallowing impairments. This systematic review provides a comprehensive discussion of the demographics, management, and outcomes of IVFP. Data Sources: PubMed and Embase databases. Review Methods: The PubMed and Embase databases were queried with the keywords “((vocal fold paralysis) OR (vocal cord paralysis)) AND (idiopathic).” Articles were selected if published between 1990 and 2023 and reported data related to patients aged ≥18 years with IVFP. Case studies and reviews were excluded. Participant demographics, presenting symptoms, and spontaneous recovery data were extracted. Results: The database query identified 509 relevant abstracts, of which 29 studies met the inclusion criteria. A total of 1238 patients with IVFP were identified with a mean age of 55.8 years (range: 40.0-70.2). Patients experienced unilateral IVFP in 97.0% of cases with 67.5% affecting the left side. The most common presenting symptoms were dysphonia (n = 78), dysphagia (n = 41), sore throat (n = 16), and cough (n = 13). Five studies reported time to presentation with a mean of 114.5 days (range: 28-341). Eleven studies found a mean spontaneous recovery rate of 31.6% (range: 11.8%-87.5%) over a mean of 139.4 days (range: 68-180). Only 4.3% of patients were documented to have a viral upper respiratory infection (URI) before developing IVFP. No specific treatments were linked to spontaneous recovery. Conclusion: There is a paucity of research describing the presentation and outcomes of patients with IVFP. Viral URI may be a potential contributing factor to IVFP development; however, more research is necessary
REACT: A Randomized Trial to Assess the Efficacy and Safety of Clazosentan for Preventing Clinical Deterioration Due to Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage
No full textOBJECTIVE Ischemic complications account for significant patient morbidity following aneurysmal subarachnoid hemorrhage (aSAH). The Prevention and Treatment of Vasospasm with Clazosentan (REACT) study was designed to assess the safety and efficacy of clazosentan, an endothelin receptor antagonist, in preventing clinical deterioration due to delayed cerebral ischemia (DCI) in patients with aSAH. METHODS REACT was a prospective, multicenter, randomized, double-blind, phase 3 study. Eligible patients had aSAH secured by surgical clipping or endovascular coiling, and had presented with thick and diffuse clot on admission CT scan. Patients were randomized (1:1 ratio) to 15 mg/hour intravenous clazosentan or placebo within 96 hours of the aSAH for up to 14 days, in addition to standard of care treatment including oral or intravenous nimodipine. The primary efficacy endpoint was the occurrence of clinical deterioration due to DCI up to 14 days after initiation of the study drug. The main secondary endpoint was the occurrence of clinically relevant cerebral infarction at day 16 after study drug initiation. Other secondary endpoints included clinical outcome assessed on the modified Rankin Scale (mRS) and the Glasgow Outcome Scale–Extended (GOSE) at week 12 post-aSAH. Imaging and clinical endpoints were centrally adjudicated. RESULTS A total of 409 patients were randomized between February 2019 and May 2022 across 74 international sites. Three patients did not start study treatment and were not included in the analysis set. The occurrence of clinical deterioration due to DCI was 15.8% (32/202 patients) in the clazosentan group and 17.2% (35/204 patients) in the placebo group, and the difference was not statistically significant (relative risk reduction [RRR] 7.2%, 95% CI –42.6% to 39.6%, p = 0.734). A nonsignificant RRR of 34.1% (95% CI –21.3% to 64.2%, p = 0.177) was observed in clinically relevant cerebral infarcts treated with clazosentan (7.4%, 15/202) versus placebo (11.3%, 23/204). Rescue therapy was less frequently needed for patients treated with clazosentan compared to placebo (10.4%, 21/202 vs 18.1%, 37/204; RRR 42.6%, 95% CI 5.4%–65.2%). A nonsignificant relative risk increase of 25.4% (95% CI –10.7% to 76.0%, p = 0.198) was reported in the risk of poor GOSE and mRS scores with clazosentan (24.8%, 50/202) versus placebo (20.1%, 41/204) at week 12 post-aSAH. Treatment-emergent adverse events were similar to those reported previously. CONCLUSIONS Clazosentan administered for up to 14 days at 15 mg/hour had no significant effect on the occurrence of clinical deterioration due to DCI. Clinical trial registration no.: NCT03585270 (ClinicalTrials.gov) EU clinical trial registration no.: 2018-000241-39 (clinicaltrialsregister.eu
A Mixed Methods Descriptive Study of a Diverse Cohort of African American/Black and Latine Young and Emerging Adults Living With HIV: Sociodemographic, Background, and Contextual Factors
No full textBackground: American/Black and Latine (AABL) young/emerging adults living with HIV in the United States (US) have consistently failed to meet targets for HIV care/medication engagement. Among this population, those with non-suppressed HIV viral load are understudied, along with immigrants and those with serious socioeconomic deprivation. Guided by social action theory, we took a mixed methods approach (sequential explanatory design) to describe sociodemographic, background, and contextual factors, and their relationships to HIV management, among a diverse cohort. Methods: Participants (N = 271) received structured baseline assessments and HIV viral load testing. Primary outcomes were being well-engaged in HIV care and HIV viral suppression. A subset (N = 41) was purposively sampled for maximum variability for in-depth interviews. Quantitative data were analyzed with descriptive statistics and logistic regression, and used to develop a research question about life contexts. Qualitative data were analyzed with directed content analysis, and the joint display method was used to integrate results. Results: Participants were 25 years old, on average (SD = 2). The majority (59%) were Latine/Hispanic and the reminder African American/Black. Almost all were assigned male sex at birth (96%) and sexual minorities (93%). Half (49%) were born outside the US and 33% spoke primarily Spanish. They were diagnosed with HIV four years prior on average (SD = 3). Most were well-engaged in HIV care (72%) and evidenced viral suppression (81%). Speaking Spanish was associated with a higher odds of care engagement, and adverse childhood experiences and income from federal benefits were associated with a lower odds. None of the factors predicted viral suppression. Qualitative results highlighted both developmentally typical (insufficient financial resources, unstable housing) and atypical challenges (struggles with large bureaucracies, HIV disclosure, daily medication use). Federal benefits and the local HIV social services administration were critical to survival. Immigrant participants came to the US to escape persecution and receive HIV care, but HIV management was often disrupted. Overall qualitative results highlighted both risk and protective factors, and resilience. Qualitative results added detail, nuance, and richness to the quantitative findings. Conclusions: The present study advances what is known about the backgrounds and contexts of diverse and understudied AABL young/emerging adults living with HIV
Understanding Vaccine Hesitancy at Montefiore Medical Center: Implications for Public Health Preparedness
No full textObjective Vaccine hesitancy among health care workers poses significant challenges to public health, particularly during times of crisis. This study investigates the factors influencing vaccine hesitancy among health care workers at Montefiore Medical Center, NY, with the aim of providing valuable insights to help shape and enhance future public health vaccination campaigns. Methods Utilizing Montefiore\u27s HER (Epic system) data from 2021-2023, linear logistic and multiple regression analyses were performed to assess correlations between demographic variables - such as age, race/ethnicity, job category, and county of residence - and vaccine uptake for both influenza and COVID-19 vaccines. Data were sourced from EPIC and Cority employee datasets. Missing demographic data were imputed where possible. The study population comprises a diverse workforce of 21 331 health care workers, encompassing a wide range of clinical and non-clinical roles. Results Key predictors of vaccine hesitancy included prior influenza vaccination status, age, race/ethnicity, job title, and county of residence. Workers vaccinated against influenza were 6.2% more likely to receive the COVID-19 vaccine. Younger health care workers and racial groups like Black and biracial employees demonstrated higher levels of hesitancy, while Asian workers exhibited higher rates of vaccine acceptance. Conclusions Tailored communication strategies and educational programs are critical for addressing vaccine hesitancy, particularly among younger health care workers and specific racial groups. Building trust and improving transparency will be essential to increasing vaccine uptake and achieving broader public health objectives
Investigating the Impact of Oral Health Status on the Prevalence of Falls Among Caregivers and Non-Caregivers in the United States: A Retrospective Study
No full textObjective: Examining the association between oral health and the prevalence of falls among US caregivers. Background: There is a scarcity of research on the association between oral health status and the prevalence of falls among older adults and caregivers. Materials and methods: Data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys from 2016 to 2020 were analyzed. The analysis was limited to individuals aged 45 years and older (n = 97 550). The outcome variable was if a person had fallen at least once during the past 12 months. The main predictor variables were the number of teeth removed, the last dentist visit, and caregiver status. Data were analyzed using bivariate descriptive statistics, chi-square tests, and logistic regression to estimate adjusted odds ratios (AORs). Results: Having one to five teeth removed was linked to an increased prevalence of falls [AOR: 1.13, 95% confidence interval (95% CI): 1.02–1.25, p =.017] and was highest for complete tooth loss (AOR: 1.35, 95% CI: 1.15–1.58, p \u3c.001). Caregivers had increased fall odds (AOR: 1.23, 95% CI: 1.10–1.38, p \u3c.001). Caregivers’ prevalence of fall increases with six or more teeth removed (AOR: 1.41, 95% CI: 1.02–1.94, p =.038) and all teeth removed (AOR: 1.47, 95% CI: 1.03–2.09, p =.030). Dental visits in the past year were associated with a 21% reduced fall risk for caregivers (AOR = 0.79, 95% CI: 0.64–0.98, p =.035). Conclusion: The study showed that maintaining good oral health and utilizing dental services may be associated with lower fall risks, particularly among caregivers, suggesting the need for integrating oral health into fall prevention strategies
Women’s Health in Rural American Communities
No full textLimited data have been published on the status of women’s health in rural areas, particularly pertaining to women of color and rural women in the United States. The aim of this review is to briefly describe the trends in women’s health in rural areas, the factors contributing to poor health outcomes and potential ways to focus improvements most effectively. To provide this overview, approximately 310 articles were screened by full text on the database PubMed. Of these, 27 articles are described in more detail in this piece. Data focus on women’s health in the United States and include information bulletin reports and individual studies centered around the topic of interest. The literature clearly illustrates that living in rural areas comes with certain limitations, lifestyle accommodations and behaviors that can lead to negative health outcomes for women in the rural United States