Metabolic syndrome (MetS) describes a cluster of cardio-metabolic factors that predispose to type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD). While 35% of Americans ...suffer from this disorder, the specific pathways related to this disease are largely underexplored. The prevailing consensus is that inflammatory pathways contribute to the pathogenesis of this disease, and therefore new research has uncovered how inflammation plays a critical role in the development and progression of MetS. The purpose of this review is to understand the role of major inflammatory mechanisms and their role in MetS. Our review identifies that adipose tissue (AT) contributes to the inflammatory pathways through the release of pro-inflammatory adipokines such as leptin and chemerin and dysregulation of anti-inflammatory adiponectin. Chemokines and cytokines deriving from monocytes are also altered and promote inflammation and insulin resistance. Circulating inflammatory biomarkers including C-reactive protein (CRP), fibrinogen, Serum amyloid A (SAA), cytokines, and chemokines have also been linked to the pathogenesis of MetS. Researchers have identified the significance of CRP levels in predicting future sequelae of MetS such as ASCVD. Mast cells in subcutaneous adipose tissue (SAT) promote both inflammation and fibrosis. Thus, both AT and phagocyte activity define MetS as an inflammatory disorder.
•Inflammation is critical in the pathogenesis of Metabolic Syndrome (MetS).•Adipose tissue dysregulation and increased monocyte/ macrophage activity appears to be pivotal in promoting inflammation.•The biomarker that is prototypic of the inflammatory burden is elevated hsCRP levels.
In 1920, the psychiatrist Abraham Myerson published a self-help book titled The Nervous Housewife. In his book, he argued that the living conditions in urban-industrial America were responsible for a ...significant increase in the number of housewives who suffered from nervous symptoms. He also warned that women were consequently becoming increasingly discontent with the role and were beginning to desire a life outside motherhood and housewifery. Accordingly, The Nervous Housewife offered housewives and their husbands directions on how to improve her living conditions. This would allow readers to manage and prevent the emergence of nervous symptoms so that women would continue to desire a life as housewife and mother. Throughout the 1920s, Myerson would continue to publish health advice for housewives on how they could manage and eliminate their nervous symptoms. This article analyzes how Myerson connected the everyday experiences and conditions of the housewife's life to her nervousness in his texts and reveals how his motivation was to keep women satisfied with what he deemed was their proper societal role, that of housewife and mother. In doing so, it will also compare his work to other self-help texts on nervousness to illuminate how his how-to guide was innovative, while examining both scholarly and popular reviews of his book to reveal what his peers and readers perceived as the benefits of his advice.
Summary
In the 1940s, Abraham Myerson’s work on drinking norms in the USA was central to reorienting the approach medical and scientific experts adopted when studying and treating alcoholism. A ...leading psychiatrist and neurologist from Boston, Myerson argued that tensions between alcohol’s ability to satisfy a pleasure-seeking drive and the rise of asceticism had generated ambivalent social attitudes, traditions and expectations towards drinking. This article explores how Myerson identified and employed social factors to uncover the relationship between ambivalent drinking norms, one’s gender, ethnic or religious background, and whether one would drink to excess. In doing so, it will illuminate how Myerson’s innovative efforts to highlight the role of social attitudes and traditions in alcoholism ultimately helped shape the approach of medical science to the alcohol problem.
•People experiencing homelessness (PEH) suboptimally engage with treatment for OUD.•Pharmacotherapy outcomes do not substantially differ between PEH and non-PEH.•Programs should encourage ...pharmacotherapy for PEH rather than detoxification alone.•MOUD clinics should adopt flexible policies to improve engagement among PEH.•Housing may improve OUD treatment outcomes for PEH but more research is needed.
The opioid-related overdose epidemic remains a persistent public health problem in the United States and has been accelerated by the 2019 coronavirus disease pandemic. Existing, evidence-based treatment options for opioid use disorder (OUD) are broadly underutilized, particularly by people experiencing homelessness (PEH). PEH are also more likely to misuse and overdose on opioids. To better understand current gaps and disparities in OUD treatment experienced by PEH and efforts to address them, we synthesized the literature reporting on the intersection of housing status and OUD treatment.
We conducted a scoping review of the literature from the electronic databases MEDLINE, Embase, PsycINFO, and Web of Science Core Collection. We included studies describing treatment-related outcomes specific to PEH and articles assessing OUD treatment interventions tailored to this population. Relevant findings were compiled via thematic analysis and narratively synthesized.
60 articles met our inclusion criteria, including 43 descriptive and 17 intervention-focused studies. These studies demonstrated that PEH experience more barriers to OUD treatment than their housed counterparts and access inpatient and detoxification treatment more commonly than pharmacotherapy. However, the reviewed literature indicated that PEH have similar outcomes once engaged in pharmacotherapy. Efficacious interventions for PEH were low-barrier and targeted, with housing interventions also demonstrating benefit.
PEH have diminished access to evidence-based OUD treatment, particularly medications, and require targeted approaches to improve engagement and retention. To mitigate the disproportionate opioid-related morbidity and mortality PEH experience, innovative, flexible, and interdisciplinary OUD treatment models are necessary, with housing support playing an important role.
OBJECTIVE:To establish evidence-based guidelines for the use of bedside cardiac ultrasound, echocardiography, in the ICU and equivalent care sites.
METHODS:Grading of Recommendations, Assessment, ...Development and Evaluation system was used to rank the “levels” of quality of evidence into high (A), moderate (B), or low (C) and to determine the “strength” of recommendations as either strong (strength class 1) or conditional/weak (strength class 2), thus generating six “grades” of recommendations (1A–1B–1C–2A–2B–2C). Grading of Recommendations, Assessment, Development and Evaluation was used for all questions with clinically relevant outcomes. RAND Appropriateness Method, incorporating the modified Delphi technique, was used in formulating recommendations related to terminology or definitions or in those based purely on expert consensus. The process was conducted by teleconference and electronic-based discussion, following clear rules for establishing consensus and agreement/disagreement. Individual panel members provided full disclosure and were judged to be free of any commercial bias.
RESULTS:Forty-five statements were considered. Among these statements, six did not achieve agreement based on RAND appropriateness method rules (majority of at least 70%). Fifteen statements were approved as conditional recommendations (strength class 2). The rest (24 statements) were approved as strong recommendations (strength class 1). Each recommendation was also linked to its level of quality of evidence and the required level of echo expertise of the intensivist. Key recommendations, listed by category, included the use of cardiac ultrasonography to assess preload responsiveness in mechanically ventilated (1B) patients, left ventricular (LV) systolic (1C) and diastolic (2C) function, acute cor pulmonale (ACP) (1C), pulmonary hypertension (1B), symptomatic pulmonary embolism (PE) (1C), right ventricular (RV) infarct (1C), the efficacy of fluid resuscitation (1C) and inotropic therapy (2C), presence of RV dysfunction (2C) in septic shock, the reason for cardiac arrest to assist in cardiopulmonary resuscitation (1B–2C depending on rhythm), status in acute coronary syndromes (ACS) (1C), the presence of pericardial effusion (1C), cardiac tamponade (1B), valvular dysfunction (1C), endocarditis in native (2C) or mechanical valves (1B), great vessel disease and injury (2C), penetrating chest trauma (1C) and for use of contrast (1B–2C depending on indication). Finally, several recommendations were made regarding the use of bedside cardiac ultrasound in pediatric patients ranging from 1B for preload responsiveness to no recommendation for RV dysfunction.
CONCLUSIONS:There was strong agreement among a large cohort of international experts regarding several class 1 recommendations for the use of bedside cardiac ultrasound, echocardiography, in the ICU. Evidence-based recommendations regarding the appropriate use of this technology are a step toward improving patient outcomes in relevant patients and guiding appropriate integration of ultrasound into critical care practice.
Abstract
Using the new medical science of endocrinology, scientific sex researchers in the 1920s and 1930s began studying sex hormone excretion as a means to search for the biological basis of human ...sexuality. One of these researchers was Abraham Myerson, a leading psychiatrist and researcher from Boston who conducted a series of innovative endocrine experiments between 1938 and 1942 in an effort to establish a relationship between sex hormone excretion patterns and homosexuality in men. While prevailing cultural models of heteronormativity identified male homosexuality as an abnormal case of biological femininity in men, Myerson’s framework and experimental research transcended this limiting duality of sexual biology. Adopting the theory of bisexuality, he argued that all men possessed a natural variability of masculine and feminine traits in their biological, social, and sexual characteristics, and that the disparity among these traits could be quantified and understood using sex hormones. In reconstructing Myerson’s research methods and data analysis, this paper uncovers how he established a distinctive diagnostic method and classification system for male homosexuality and illuminates how he conceptualized and categorized male sexuality as quantifiable and independent of personality.
ABSTRACTThe aim of the study was to identify oral baclofen dosing variability at steady state based on weight and Gross Motor Function Classification System level using a retrospective ...cross-sectional study design. The medical records of 500 pediatric aged patients (age 1–21 yrs) were reviewed to obtain 144 pediatric patients who met inclusion criteria. One-way analysis of variance tests revealed increasing mean doses in baclofen (in milligram per kilogram) with higher Gross Motor Function Classification System levels (P = 0.001). Post hoc Tukey analysis showed patients with higher ambulatory ability (Gross Motor Function Classification System I–II) received a lower total daily dosage than did patients with less ambulatory ability (Gross Motor Function Classification System III–V). A moderate correlation was observed with increasing oral baclofen dose as weight increased (r = 0.43, P < 0.0001). Because of the variability in dosing between Gross Motor Function Classification System levels, prescribing oral baclofen for pediatric patients with cerebral palsy may not follow the traditional model of weight-based dosing seen in other pediatric conditions.
Light-driven H(2) production is catalyzed by Ni(P(2)(Ph)N(2)(Ph))(2)(BF(4))(2) when irradiated with visible light in water/acetonitrile mixed solvent in the presence of a photosensitizer (PS) and ...ascorbate. The catalyst gives over 2700 turnovers over 150 h, and does not degrade despite photodecomposition of the PS.
Many patients are not adherent to hand therapy rehabilitation following surgical repair of traumatic flexor tendon injuries, which can negatively affect surgical outcomes and long-term hand function. ...The authors aimed to identify the factors that predict patient nonadherence to hand therapy following flexor tendon repair surgery.
This retrospective cohort study included 154 patients who underwent surgical repair of flexor tendon injuries at a level I trauma center between January of 2015 and January of 2020. A manual chart review was performed to collect demographic data, insurance status, injury characteristics, and details of the postoperative course, including health care use.
Factors significantly associated with occupational therapy no-shows included Medicaid insurance (OR, 8.35; 95% CI, 2.91 to 24.0; P < 0.001), self-identified Black race (OR, 7.28; 95% CI, 1.78 to 29.7; P = 0.006), and current cigarette smoker status (OR, 2.69; 95% CI, 1.18 to 6.15; P = 0.019). Patients without insurance attended 73.8% of their occupational therapy visits, and patients with Medicaid attended 72.0% of their visits, rates significantly lower than the rate of those with private insurance (90.7%; P = 0.026 and P = 0.001, respectively). Patients with Medicaid were eight times more likely to seek emergency department care postoperatively than patients with private insurance ( P = 0.002).
Significant disparities in hand therapy adherence following flexor tendon repair surgery exist between patients with different insurance statuses, races, and tobacco use. Understanding these disparities can help providers identify at-risk patients to improve hand therapy use and postoperative outcomes.
Risk, II.
Children with traumatic brain injury (TBI) represent a unique and evolving population. Recovery and long-term prognosis are variable given the heterogeneity of ages, developmental stages, and types ...of injuries. This article summarizes important information regarding severe TBI epidemiology, pathophysiology, classification, and acute management. Early and longitudinal involvement of rehabilitation experts, such as pediatric physiatrists, is critical in managing complications and optimizing outcomes.
