Having multiple (two or more) chronic conditions (MCC) is associated with an increased risk of mortality and functional decline, health resource utilization, and healthcare expenditures. As a result, ...understanding the prevalence of MCC is increasingly being recognized as a public health imperative. This research describes the prevalence and distribution of adults with MCC across the United States using 2017 data from the Behavioral Risk Factors Surveillance System (BRFSS). Prevalence of MCC was calculated for each U.S. state and territory overall, by sex and by age. Additionally, the most common condition dyads (two condition combinations) and triads (three condition combinations) were assessed for each state. Prevalence of MCC ranged from 37.9% in the District of Columbia to 64.4% in West Virginia. Females had a higher prevalence than males in 47 of 53 states and territories, and MCC prevalence increased with age in every state and territory. Overall prevalence estimates were higher than estimates using data from the National Health Interview Survey (NHIS), especially in the younger population (aged 18-44), due partly to the inclusion of high cholesterol, obesity, and depression as chronic conditions. Analysis of the most prevalent dyads and triads revealed the greatest state-by-state variability in the 18-44-year-old population. Multiple states' most prevalent dyads and triads for this population included obesity and depression. These findings build an accurate picture of the prevalence of multiple chronic conditions across the United States and will aid public health officials in creating programs targeted to their region.
Chronic stress can impact decision-making and lead to a preference for immediate rewards rather than long-term payoffs. Factors that may influence these effects of chronic stress on decision-making ...are under-explored. Here we used a mouse model to investigate the changes in decision-making caused by the experience of chronic stress and the role of social isolation in exaggerating these changes. To test decision-making, mice were trained to perform a Cost-Benefit Conflict (CBC) task on a T-maze, in which they could choose between a high-reward, high-risk alternative and a low-reward, low-risk alternative. Mice were either housed in groups or alone throughout the experiment. Both groups of mice underwent a seven-day period of repeated immobilisation to induce chronic stress. Stress levels were confirmed using behavioural (open field test) and physiological (urine corticosterone ELISA) measures. We found a significant increase in frequency of high-risk decisions after exposure to chronic stress among both socially- and individually-housed mice. Crucially, socially-housed mice showed a significantly smaller increase in high-risk decision-making compared to singly-housed mice. These findings suggest that chronic stress leads to an increase in high-risk decision-making in mice, and that lack of social interaction may exacerbate this stress effect.
Medical societies have embraced advocacy as a core professional competency, but little is known about how entering medical students view physician advocacy. This study examined how first year medical ...students define advocacy, their motivations for and anticipated challenges to advocacy, and whether they believe advocacy should be a core competency.
This study used a qualitative content analysis approach to analyze first year medical student narrative responses about physician advocacy. The analysis included the written responses of 95% of the first-year medical students at the University of California, San Francisco (UCSF) School of Medicine during two academic years.
Students shared consensus that physicians should advocate on behalf of their individual patients. Students had varying opinions on whether all physicians should engage in societal level advocacy and whether it should be a core competency in medical school. Students find several compelling reasons for physicians to engage in societal advocacy but nevertheless anticipate challenges to physician advocacy.
Given increasing consensus that advocacy is a core competency of physicians, providing medical students the skills to successfully engage in advocacy is increasingly important. Any new mandatory curricula will need to focus on how to engage learners with varied views on advocacy.
The homeless population is aging; older homeless adults may be at high risk of experiencing violent victimization. To examine whether homelessness is independently associated with experiencing ...physical and sexual abuse, we recruited 350 adults, aged 50 and older in Oakland, California, who met criteria for homelessness between July 2013 and June 2014. We interviewed participants at 6-month intervals for 3 years in Oakland about key variables, including housing status. Using generalized estimating equations, we examined whether persistent homelessness in each follow-up period was independently associated with having experienced physical or sexual victimization, after adjusting for known risk factors. The majority of the cohort was men (77.4%) and Black American (79.7%). At baseline, 10.6% had experienced either physical or sexual victimization in the prior 6 months. At 18-month follow-up, 42% of the cohort remained homeless. In adjusted models, persistent homelessness was associated with twice the odds of victimization (adjusted odds ratio AOR = 2.01; 95% confidence interval CI: 1.41, 2.87). Older homeless adults experience high rates of victimization. Re-entering housing reduces this risk. Policymakers should recognize exposure to victimization as a negative consequence of homelessness that may be preventable by housing.
AIM: To evaluate the safety of endoscopic procedures in neutropenic and/or thrombocytopenic cancer patients. METHODS: We performed a literature search for English language studies in which patients ...with neutropenia and/or thrombocytopenia underwent endoscopy. Studies were included if endoscopic procedures were used as part of the evaluation of neutropenic and/or thrombocytopenic patients,yielding 13 studies. Two studies in which endoscopy was not a primary evaluation tool were excluded. Eleven relevant studies were identified by two independent reviewers on Pub Med,Scopus,and Ovid databases.RESULTS: Most of the studies had high diagnostic yield with relatively low complication rates. Therapeutic endoscopic interventions were performed in more than half the studies,including high-risk procedures,such as sclerotherapy. Platelet transfusion was given if counts were less than 50000/mm3 in four studies and less than 10000/mm3 in one study. Other thrombocytopenic precautions included withholding of biopsy if platelet count was less than 30000/mm3 in one study and less than 20000/mm3 in another study. Two of the ten studies which examined thrombocytopenic patient populations reported bleeding complications related to endoscopy,none of which caused major morbidity or mortality. All febrile neutropenic patients received prophylactic broad-spectrum antibiotics in the studies reviewed. Regarding afebrile neutropenic patients,prophylactic antibiotics were given if absolute neutrophil count was less than 1000/mm3 in one study,if the patient was undergoing colonoscopy and had a high inflammatory condition without clear definition of significance in another study,and if the patient was in an aplastic phase in a third study. Endoscopy was also withheld in one study for severe pancytopenia. CONCLUSION: Endoscopy can be safely performed in patients with thrombocytopenia/neutropenia. Prophylactic platelet transfusion and/or antibiotic administration prior to endoscopy may be considered in some cases and should be individualized.
MRI is commonly used to aid breast cancer diagnosis and treatment evaluation. For patients with breast cancer, neoadjuvant chemotherapy aims to reduce the tumor size and extent of surgery necessary. ...The current clinical standard to measure breast tumor response on MRI uses the longest tumor diameter. Radiologists also account for other tissue properties including tumor contrast/pharmacokinetics in their assessment. Accurate longitudinal image registration of breast tissue is critical to properly compare response to treatment at different timepoints.PURPOSEMRI is commonly used to aid breast cancer diagnosis and treatment evaluation. For patients with breast cancer, neoadjuvant chemotherapy aims to reduce the tumor size and extent of surgery necessary. The current clinical standard to measure breast tumor response on MRI uses the longest tumor diameter. Radiologists also account for other tissue properties including tumor contrast/pharmacokinetics in their assessment. Accurate longitudinal image registration of breast tissue is critical to properly compare response to treatment at different timepoints.In this study, a deformable Fast Longitudinal Image Registration (FLIRE) algorithm was optimized for breast tissue. FLIRE was then compared to the publicly available software packages with high accuracy (DRAMMS) and fast runtime (Elastix). Patients included in the study received longitudinal T1 weighted MRI without fat saturation at two to six timepoints as part of asymptomatic screening (n = 27) or throughout neoadjuvant chemotherapy treatment (n = 32). T1 weighted images were registered to the first timepoint with each algorithm.METHODSIn this study, a deformable Fast Longitudinal Image Registration (FLIRE) algorithm was optimized for breast tissue. FLIRE was then compared to the publicly available software packages with high accuracy (DRAMMS) and fast runtime (Elastix). Patients included in the study received longitudinal T1 weighted MRI without fat saturation at two to six timepoints as part of asymptomatic screening (n = 27) or throughout neoadjuvant chemotherapy treatment (n = 32). T1 weighted images were registered to the first timepoint with each algorithm.Alignment and runtime performance were compared using two-way repeated measure ANOVAs (P < 0.0 5). Across all patients, Pearson's correlation coefficient across the entire image volume was slightly higher with statistical significance and had less variance for FLIRE (0.98 ± 0.01 stdev) compared to DRAMMS (0.97 ± 0.03 stdev) and Elastix (0.9 5 ± 0.03 stdev). Additionally, FLIRE runtime (10.0 mins) was 9.0 times faster than DRAMMS (89.6 mins) and 1.5 times faster than Elastix (14.5 mins) on a Linux workstation.RESULTSAlignment and runtime performance were compared using two-way repeated measure ANOVAs (P < 0.0 5). Across all patients, Pearson's correlation coefficient across the entire image volume was slightly higher with statistical significance and had less variance for FLIRE (0.98 ± 0.01 stdev) compared to DRAMMS (0.97 ± 0.03 stdev) and Elastix (0.9 5 ± 0.03 stdev). Additionally, FLIRE runtime (10.0 mins) was 9.0 times faster than DRAMMS (89.6 mins) and 1.5 times faster than Elastix (14.5 mins) on a Linux workstation.FLIRE demonstrates promise for time-sensitive clinical applications due to its accuracy, robustness across patients and timepoints, and speed.CONCLUSIONFLIRE demonstrates promise for time-sensitive clinical applications due to its accuracy, robustness across patients and timepoints, and speed.
A 2D U-Net was trained to generate synthetic T1p maps from T2 maps for knee MRI to explore the feasibility of domain adaptation for enriching existing datasets and enabling rapid, reliable image ...reconstruction. The network was developed using 509 healthy contralateral and injured ipsilateral knee images from patients with ACL injuries and reconstruction surgeries acquired across three institutions. Network generalizability was evaluated on 343 knees acquired in a clinical setting and 46 knees from simultaneous bilateral acquisition in a research setting. The deep neural network synthesized high-fidelity reconstructions of T1p maps, preserving textures and local T1p elevation patterns in cartilage with a normalized mean square error of 2.4% and Pearson’s correlation coefficient of 0.93. Analysis of reconstructed T1p maps within cartilage compartments revealed minimal bias (−0.10 ms), tight limits of agreement, and quantification error (5.7%) below the threshold for clinically significant change (6.42%) associated with osteoarthritis. In an out-of-distribution external test set, synthetic maps preserved T1p textures, but exhibited increased bias and wider limits of agreement. This study demonstrates the capability of image synthesis to reduce acquisition time, derive meaningful information from existing datasets, and suggest a pathway for standardizing T1p as a quantitative biomarker for osteoarthritis.
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