IMPORTANCE: Microglia, the resident immune cells of the central nervous system, play an important role in the brain’s response to injury and neurodegenerative processes. It has been proposed that ...prolonged microglial activation occurs after single and repeated traumatic brain injury, possibly through sports-related concussive and subconcussive injuries. Limited in vivo brain imaging studies months to years after individuals experience a single moderate to severe traumatic brain injury suggest widespread persistent microglial activation, but there has been little study of persistent glial cell activity in brains of athletes with sports-related traumatic brain injury. OBJECTIVE: To measure translocator protein 18 kDa (TSPO), a marker of activated glial cell response, in a cohort of National Football League (NFL) players and control participants, and to report measures of white matter integrity. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional, case-control study included young active (n = 4) or former (n = 10) NFL players recruited from across the United States, and 16 age-, sex-, highest educational level–, and body mass index–matched control participants. This study was conducted at an academic research institution in Baltimore, Maryland, from January 29, 2015, to February 18, 2016. MAIN OUTCOMES AND MEASURES: Positron emission tomography–based regional measures of TSPO using 11CDPA-713, diffusion tensor imaging measures of regional white matter integrity, regional volumes on structural magnetic resonance imaging, and neuropsychological performance. RESULTS: The mean (SD) ages of the 14 NFL participants and 16 control participants were 31.3 (6.1) years and 27.6 (4.9) years, respectively. Players reported a mean (SD) of 7.0 (6.4) years (range, 1-21 years) since the last self-reported concussion. Using 11CDPA-713 positron emission tomographic data from 12 active or former NFL players and 11 matched control participants, the NFL players showed higher total distribution volume in 8 of the 12 brain regions examined (P < .004). We also observed limited change in white matter fractional anisotropy and mean diffusivity in 13 players compared with 15 control participants. In contrast, these young players did not differ from control participants in regional brain volumes or in neuropsychological performance. CONCLUSIONS AND RELEVANCE: The results suggest that localized brain injury and repair, indicated by higher TSPO signal and white matter changes, may be associated with NFL play. Further study is needed to confirm these findings and to determine whether TSPO signal and white matter changes in young NFL athletes are related to later onset of neuropsychiatric symptoms.
Infections from methicillin-resistant
are increasingly treated in longterm care facilities, but long-term care pharmacies face high costs in the provision of sterile vancomycin for intravenous ...administration. This study compares pharmaceutical costs of outsourced, compounded, and room temperature premixed vancomycin formulations in a long-term care pharmacy.
This retrospective observational study reviewed 124 orders of vancomycin. Means for total pharmacy preparation time, pharmacist labor time, and extrapolated time over complete course of treatment were compared for three vancomycin preparations: outsourced, compounded by pharmacy, and room temperature premixed vancomycin formulations. Cost calculations were generated using ingredient costs as reported by the pharmacy and median pharmacist labor costs as published from national sources.
Mean total preparation times and pharmacist preparation times were shortest for premixed vancomycin. Over full courses of treatment, mean pharmacy preparation time for compounded was 5 hours 3 minutes (mean of 28 treatments) and 2 hours 8 minutes for premixed (mean of 54 treatments). Data on pharmacist time in outsourced orders were not available. Total pharmacy costs were $993.94 for compounded vancomycin, $2220.34 for outsourced, and $809.36 for room temperature premixed vancomycin.
There were reduced preparation times for room temperature premixed vancomycin compared with compounded and outsourced formulations for skilled nursing facilities. As multiple drug-resistant organism infections are increasingly treated in long-term care, finding cost-effective approaches to medication provision from pharmacies is critical.
In health care, the year 2020 is marked by the ongoing coronavirus (COVID-19) pandemic, with much research published to clarify infection risk, treatment approaches, and proposed interventions to ...reduce spread and combat complications. Although much work focused on COVID-19, medication safety remains a priority, and studies on adverse drug reactions, high-risk medications, and approaches to mitigate risk associated with chronic medication use, such as inappropriate dosing in hospital settings, were published. A continued commitment to patient-centered care, such as the approach put forth by the Age-Friendly Health Systems initiative and telehealth initiatives, ensures that even as health care practice strives to meet the challenge of an unprecedented global pandemic, safe medication use informed by patient needs continues to guide best practices through lessons learned. Journal of Gerontological Nursing, 47(1), 7-11..
The current article provides an overview of an interprofessional service-learning course that became virtual in the setting of the coronavirus disease 2019 pandemic. Telehealth video technologies ...were used to build an intergenerational, virtual classroom and increase engagement of older adults with interdisciplinary health professional students. The virtual classroom involved group health education sessions, individualized Medicare wellness visits, and a clinical huddle. The course addressed the public health need for reliable health information during the early days of the pandemic, social connection, and meeting the educational goals for health care students and older adults in a novel virtual setting. Lessons learned for the interdisciplinary team and for engaging older adults included the need for preparation reading, team building exercises, training videos, and telehealth competency checklists. Beyond the pandemic, adoption of virtual methods enables hybrid approaches to interprofessional education and builds competencies for delivery of telehealth and computer-based visits in professional practice settings.
Journal of Gerontological Nursing, 48
(8), 52–56.
Medication reviews through Medicare's Medication Therapy Management (MTM) program may improve patient outcomes and lower health system costs, but these effects could be limited by a program design ...that does not address social determinants of health.
To analyze the effects of social determinants of health on the odds of an eligible Medicare beneficiary not being offered Comprehensive Medication Review (CMR).
Using the full 100% sample of the 2016 Part D Medication Therapy Management Data File linked to Medicare Master Beneficiary Summary File, a retrospective, cross-sectional analysis was conducted to determine which social and demographic variables are most strongly associated with being eligible for a CMR but not being offered one. Descriptive statistics were generated using SAS studio 3.8.
Variables associated with the highest odds of not receiving a CMR when eligible are residence in Louisiana OR 1.79 (95%CI 1.70–1.88), receiving the LIS OR 1.76 (1.73–1.79), dual eligibility for Medicare and Medicaid OR 1.25 (1.12–1.41), and Black race OR 1.19 (1.16–1.21).
Social determinants of health, most strongly geography and low-income status, predict being eligible for but not being offered CMR. Race continues to be a factor in disparate access to MTM services.
Municipal drinking water, regulated by the Environmental Protection Agency via the Safe Drinking Water act, has long been assumed to be contaminant-free. However, crises related to drinking water ...have emerged, most notably the “Flint Water Crisis” in Flint, MI, where high levels of lead (Pb) were detected in the area’s water. Much of the water-sampling data collected in Flint was obtained by “Citizen Scientists” working closely with a team of researchers at Virginia Tech, who used the analytical technique of Inductively Coupled Plasma Mass Spectrometry (ICP-MS) to quantify metal ions present in the water. Inspired by these efforts, we developed adaptable public water testing outreach efforts, led by students in Baltimore city (Middle School, High School, and College), to test the city’s drinking water. These “student-scientists” read news and scientific articles to understand the public health impact of lead in drinking water and the analytical approaches scientists use to detect metal ions in water. The students then developed a written “water collection protocol” and sought participation from colleagues (other students, faculty, and staff) who collected their home drinking water to be tested. The student scientists prepared and analyzed samples for lead (Pb) as well as copper (Cu), iron (Fe), and zinc (Zn) metal ions commonly found in drinking water, to be tested via ICP-MS. Data were then plotted onto a map of Baltimore City, with the metal levels indicated for each Zip code. This outreach event connects science to real-life news events while teaching analytical methodology and can be tailored to students at various stages of their education.
I read Jeffrey Eugenides' 2002 novel Middlesex as a book that endorses a narrative of heteronormativity and ethnic assimilation. Ethnocentrism is critiqued through irony, first with an incestuous ...marriage and then by parodying the Nation of Islam. But on the question of homosexuality, the text appears to stage the impasse of sexuality and gender, only to resolve its complexities as a coming of age narrative that affirms heterosexuality.
I read Jeffrey Eugenides' 2002 novel Middlesex as a book that endorses a narrative of heteronormativity and ethnic assimilation. Ethnocentrism is critiqued through irony, first with an incestuous ...marriage and then by parodying the Nation of Islam. But on the question of homosexuality, the text appears to stage the impasse of sexuality and gender, only to resolve its complexities as a coming of age narrative that affirms heterosexuality. PUBLICATION ABSTRACT
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