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Call to action: Understanding the differences in the use of SGLT-2 inhibitors and GLP-1 receptor agonists.
No full textCardiovascular disease remains one of the most prominent global health problems and has been demonstrated to disproportionally affect certain communities. Despite an increasing collective effort to improve health inequalities, a multitude of disparities continue to affect cardiovascular outcomes. Among the most prominent disparities within cardiovascular disease prevention are with the use and distribution of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists. Several landmark trials have demonstrated the efficacy of these novel agents, not only in cardiovascular disease prevention among those with diabetes, but also in heart failure and chronic kidney disease. However, the use of these agents remains limited by disparities in certain racial/ethnic, sex, and socioeconomic groups. This review works to highlight and understand these differences on the use and prescribing patterns of pivotal agents in cardiovascular disease prevention, SGLT-2 inhibitors and GLP-1 agonists. Our aim is to enrich understanding and to inspire efforts to end disparities in cardiovascular morbidity and mortality due to race, sex and income inequality
Implementation Strategies to Improve Evidence-Based Bathing Practices in a Neuro ICU.
No full textBackgroundEvidence supports daily bathing using chlorhexidine gluconate (CHG) cloths to decrease preventable hospital-acquired central line-associated bloodstream infections (CLABSIs). However, implementation of this practice is inconsistent. Using multifaceted strategies to promote implementation is supported in the literature, yet there is a gap in knowing which strategies are most successful.PurposeUsing the Grol and Wensing Model of Implementation as a guide, the purpose of this study was to determine whether using tailored, multifaceted strategies would improve implementation of daily CHG bathing and decrease CLABSIs in a large neuro ICU.MethodsAn observational pre-/postdesign was used.ResultsFollowing implementation, infection rates decreased (P = .031). Statistically significant improvements were also seen across all process measures: bathing documentation, nursing knowledge, and perceived importance of CHG bathing.ConclusionsThis study assists in closing the research-practice gap by using tailored, multifaceted implementation strategies to increase use of evidence-based nursing care for infection prevention practices
Strongly correlated photons generated by coupling a three- or four-level system to a waveguide
No full textWe study the generation of strongly correlated photons by coupling an atom to photonic quantum fields in a one-dimensional waveguide. Specifically, we consider a three-level or four-level system for the atom. Photon-photon bound states emerge as a manifestation of the strong photon-photon correlation mediated by the atom. Effective repulsive or attractive interaction between photons can be produced, causing either suppressed multiphoton transmission (photon blockade) or enhanced multiphoton transmission (photon-induced tunneling). As a result, nonclassical light sources can be generated on demand by sending coherent states into the proposed system. We calculate the second-order correlation function of the transmitted field and observe bunching and antibunching caused by the bound states. Furthermore, we demonstrate that the proposed system can produce photon pairs with a high degree of spectral entanglement, which have a large capacity for carrying information and are important for large-alphabet quantum communication. © 2012 American Physical Society
Olfactory Drug Delivery with Intranasal Sprays after Nasal Midvault Reconstruction.
No full textConductive olfaction and nose to brain drug delivery are important processes that remain limited by inadequate odorant or drug delivery to the olfactory airspace. Primary challenges include anatomic barriers and poor targeting to the olfactory region. This study uses computational fluid dynamics to investigate the effects of nasal midvault surgery on olfactory drug delivery with intranasal sprays. Soft tissue elevation, spreader flaps, and spreader grafts were performed on two fresh cadaveric specimens, using computed tomography for airway reconstruction. Nasal airflow and drug particle transport simulations were performed under these conditions: inhalation rate (15, 30L/min), spray velocity (1, 5, 10m/s), spray location (top, bottom, center, medial, lateral), head position (upright, supine, forward, backward), and particle size (1-100 µm). Simulation results were used to calculate drug particle deposition to the olfactory airspaces and bulbs. Total olfactory deposition was <5% but attained a maximum of 36.33% when sorted by particle size. There was no association between nasal midvault surgery and olfactory deposition. No single parameter or technique demonstrated superior olfactory deposition, but smaller particle size, slower spray velocity, and higher inhalation rate tended to optimize olfactory deposition, providing important implications for future intranasal spray and drug design to target the olfactory airspace
How Weakly Institutionalized Parties Monitor Brokers in Developing Democracies: Evidence from Postconflict Liberia
No full textCorrection to: Combining adult with pediatric patient data to develop a clinical decision support tool intended for children: leveraging machine learning to model heterogeneity.
No full textFollowing publication of the original article [1], it was reported that part of the ‘Outcome Variable Definition’ and the entirety of the ‘Descriptive statistics’ subsection was missing. These two subsections are given below with the previously missing text highlighted in bold. The original article [1] has been updated. Outcome Variable Definition In the initial development of the CDS tool, we were tasked with predicting four outcomes related to hospital resource utilization: overall length of stay, admission to the intensive care unit (ICU), requirement for mechanical ventilation, and discharge to a skilled nursing facility. Because children are rarely discharged to a skilled nursing facility and evaluating continuous outcomes poses unique challenges, we focused on the two binary outcomes: admission to the ICU and requirement for mechanical ventilation. Statistical Analysis Descriptive statistics We compared the pediatric and adult patient populations. We report standardized mean differences (SMDs) where an SMD > 0.10 indicates that the two groups are out of balance
Three-dimensional tissue-engineered human skeletal muscle model of Pompe disease.
No full textIn Pompe disease, the deficiency of the lysosomal enzyme acid alpha-glucosidase (GAA) causes skeletal and cardiac muscle weakness, respiratory failure, and premature death. While enzyme replacement therapy using recombinant human GAA (rhGAA) can significantly improve patient outcomes, detailed disease mechanisms and incomplete therapeutic effects require further studies. Here we report a three-dimensional primary human skeletal muscle ("myobundle") model of infantile-onset Pompe disease (IOPD) that recapitulates hallmark pathological features including reduced GAA enzyme activity, elevated glycogen content and lysosome abundance, and increased sensitivity of muscle contractile function to metabolic stress. In vitro treatment of IOPD myobundles with rhGAA or adeno-associated virus (AAV)-mediated hGAA expression yields increased GAA activity and robust glycogen clearance, but no improvements in stress-induced functional deficits. We also apply RNA sequencing analysis to the quadriceps of untreated and AAV-treated GAA-/- mice and wild-type controls to establish a Pompe disease-specific transcriptional signature and reveal novel disease pathways. The mouse-derived signature is enriched in the transcriptomic profile of IOPD vs. healthy myobundles and partially reversed by in vitro rhGAA treatment, further confirming the utility of the human myobundle model for studies of Pompe disease and therapy
Defining the Need for Causal Inference to Understand the Impact of Social Determinants of Health: A Primer on Behalf of the Consortium for the Holistic Assessment of Risk in Transplantation (CHART).
No full textObjectiveThis study aims to introduce key concepts and methods that inform the design of studies that seek to quantify the causal effect of social determinants of health (SDOH) on access to and outcomes following organ transplant.BackgroundThe causal pathways between SDOH and transplant outcomes are poorly understood. This is partially due to the unstandardized and incomplete capture of the complex interactions between patients, their neighborhood environments, the tertiary care system, and structural factors that impact access and outcomes. Designing studies to quantify the causal impact of these factors on transplant access and outcomes requires an understanding of the fundamental concepts of causal inference.MethodsWe present an overview of fundamental concepts in causal inference, including the potential outcomes framework and direct acyclic graphs. We discuss how to conceptualize SDOH in a causal framework and provide applied examples to illustrate how bias is introduced.ResultsThere is a need for direct measures of SDOH, increased measurement of latent and mediating variables, and multi-level frameworks for research that examine health inequities across multiple health systems to generalize results. We illustrate that biases can arise due to socioeconomic status, race/ethnicity, and incongruencies in language between the patient and clinician.ConclusionsProgress towards an equitable transplant system requires establishing causal pathways between psychosocial risk factors, access, and outcomes. This is predicated on accurate and precise quantification of social risk, best facilitated by improved organization of health system data and multicenter efforts to collect and learn from it in ways relevant to specialties and service lines
The Roles of Capping Agents and Defects in the Anisotropic Growth of Ag Nanocrystals
No full textSynthetic control of metal nanocrystal shape is a common strategy to control their properties. Shape control is often achieved by controlling the crystal structure of the seed crystals, as well as through the use of additives which are thought to block atomic addition to certain facets. However, the effect of crystal structure or additives on the rate of atomic addition to a specific facet is not usually quantified, making it difficult to design nanocrystal syntheses. This work combines seed-mediated growth, single-crystal electrochemistry measurements and Raman spectroscopy to understand the roles of capping agents and planar defects in the anisotropic growth of silver nanocrystals. The roles of citrate, polyvinylpyrrolidone (PVP), and halides have been investigated. Synthetic results show citrate is a {111} capping agent, PVP is a weak {111} capping agent, chloride and bromide are weak {100} capping agents. However, when chloride or bromide is added with PVP, they become strong {100} capping agents. Electrochemical measurements show the anisotropic growth is caused by capping agents selectively suppressing the oxidation of ascorbic acid (a reducing agent) on a specific crystal facet. The effect of capping agents on silver ion reduction is not facet-selective. Further comparison between the growth of single-crystal seeds and seeds with planar defects indicates defects can catalyze silver atom deposition by up to 100 times and cause greater anisotropic growth than can be explained by facet-selective passivation. Overall this work advances our understanding of nanocrystal chemistry, and informs the design of nanocrystal synthesis to obtain a desired nanocrystal morphology with a desired set of properties.</p
Degenerative Spinal Deformity.
No full textDegenerative spinal deformity afflicts a significant portion of the elderly and is increasing in prevalence. Recent evidence has revealed sagittal plane malalignment to be a key driver of pain and disability in this population and has led to a significant shift toward a more evidence-based management paradigm. In this narrative review, we review the recent literature on the epidemiology, evaluation, management, and outcomes of degenerative adult spinal deformity (ASD). ASD is increasing in prevalence in North America due to an aging population and demographic shifts. It results from cumulative degenerative changes focused in the intervertebral discs and facet joints that occur asymmetrically to produce deformity. Deformity correction focuses on restoration of global alignment, especially in the sagittal plane, and decompression of the neural elements. General realignment goals have been established, including sagittal vertical axis <50 mm, pelvic tilt <22°, and lumbopelvic mismatch <±9°; however, these should be tailored to the patient. Operative management, in carefully selected patients, yields satisfactory outcomes that appear to be superior to nonoperative strategies. ASD is characterized by malalignment in the sagittal and/or coronal plane and, in adults, presents with pain and disability. Nonoperative management is recommended for patients with mild, nonprogressive symptoms; however, evidence of its efficacy is limited. Surgery aims to restore global spinal alignment, decompress neural elements, and achieve fusion with minimal complications. The surgical approach should balance the desired correction with the increased risk of more aggressive maneuvers. In well-selected patients, surgery yields excellent outcomes