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Annals of Surgical Oncology Jun 2024More than 2.5 million adults in the United States identify as transgender or gender-diverse (TGD), but little data exist on cancer screening and care for this...
BACKGROUND
More than 2.5 million adults in the United States identify as transgender or gender-diverse (TGD), but little data exist on cancer screening and care for this population. We examined cancer characteristics, screening adherence, genetic testing, and provider inclusive language for TGD patients with cancer.
METHODS
This single institution retrospective cohort study identified TGD patients with cancer between 2000 and 2022. Demographic, clinicopathological, treatment, and screening data were collected, as well as data on gender-affirming care (GAC) and use of patients' personal pronouns in medical records. Descriptive statistics and regression analyses were used to report outcomes.
RESULTS
Sixty unique patients with 69 cancer diagnoses were included: 63.3% were transgender women, 21.7% transgender men, 6.7% nonbinary, and 8.3% were genderqueer. Sixty-five percent had a family history of cancer. Only 46.2% of those who met genetic testing criteria were referred. On review of recommended cancer screening, colorectal screening had the greatest uptake (62%), followed by breast (48.3%), lung (35.7%), cervical (33.3%), and prostate (32%); 8.5% of cancers were diagnosed on screening. Individuals with Medicare had reduced odds of screening uptake (OR 0.07, 95% CI 0.01-0.58) versus private insurance. With respect to GAC, 73.3% used gender-affirming hormone therapy and 41% had gender-affirming surgery. After initiating GAC and asserting personal pronouns, 75% were referred to by incorrect name/pronouns in provider documentation.
CONCLUSIONS
Our TGD cancer patient cohort had low rates of disease-specific cancer screening and inadequate genetic referrals. Many providers did not use appropriate patient names/pronouns. Provider and patient interventions are needed to ensure inclusive preventative and oncologic care for this marginalized population.
PubMed: 38861206
DOI: 10.1245/s10434-024-15319-4 -
Journal of Clinical & Translational... Jun 2024To report the safety and side effects associated with taking verapamil for beta-cell preservation in children with newly-diagnosed T1D.
OBJECTIVES
To report the safety and side effects associated with taking verapamil for beta-cell preservation in children with newly-diagnosed T1D.
RESEARCH DESIGN AND METHODS
Eighty-eight participants aged 8.5 to 17.9 years weighing ≥ 30 kg were randomly assigned to verapamil (N = 47) or placebo (N = 41) within 31 days of T1D diagnosis and followed for 12 months from diagnosis, main CLVer study. Drug dosing was weight-based with incremental increases to full dosage. Side effect monitoring included serial measurements of pulse, blood pressure, liver enzymes, and electrocardiograms (ECGs). At study end, participants were enrolled in an observational extension study (CLVerEx), which is ongoing. No study drug is provided during the extension, but participants may use verapamil if prescribed by their diabetes care team.
RESULTS
Overall rates of adverse events were low and comparable between verapamil and placebo groups. There was no difference in the frequency of liver function abnormalities. Three CLVer participants reduced or discontinued medication due to asymptomatic ECG changes. One CLVerEx participant (18 years old), treated with placebo during CLVer, who had not had a monitoring ECG, experienced complete AV block with a severe hypotensive episode 6 weeks after reaching his maximum verapamil dose following an inadvertent double dose on the day of the event.
CONCLUSIONS
The use of verapamil in youth newly-diagnosed with T1D appears generally safe and well tolerated with appropriate monitoring. We strongly recommend monitoring for potential side effects including an ECG at screening and an additional ECG once full dosage is reached.ClinicalTrials.gov number: NCT04233034.
PubMed: 38860154
DOI: 10.1016/j.jcte.2024.100352 -
The Journal of Headache and Pain Jun 2024Mindfulness practice has gained interest in the management of Chronic Migraine associated with Medication Overuse Headache (CM-MOH). Mindfulness is characterized by... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Mindfulness practice has gained interest in the management of Chronic Migraine associated with Medication Overuse Headache (CM-MOH). Mindfulness is characterized by present-moment self-awareness and relies on attention control and emotion regulation, improving headache-related pain management. Mindfulness modulates the Default Mode Network (DMN), Salience Network (SN), and Fronto-Parietal Network (FPN) functional connectivity. However, the neural mechanisms underlying headache-related pain management with mindfulness are still unclear. In this study, we tested neurofunctional changes after mindfulness practice added to pharmacological treatment as usual in CM-MOH patients.
METHODS
The present study is a longitudinal phase-III single-blind Randomized Controlled Trial (MIND-CM study; NCT03671681). Patients had a diagnosis of CM-MOH, no history of neurological and severe psychiatric comorbidities, and were attending our specialty headache centre. Patients were divided in Treatment as Usual (TaU) and mindfulness added to TaU (TaU + MIND) groups. Patients underwent a neuroimaging and clinical assessment before the treatment and after one year. Longitudinal comparisons of DMN, SN, and FPN connectivity were performed between groups and correlated with clinical changes. Vertex-wise analysis was performed to assess cortical thickness changes.
RESULTS
177 CM-MOH patients were randomized to either TaU group or TaU + MIND group. Thirty-four patients, divided in 17 TaU and 17 TaU + MIND, completed the neuroimaging follow-up. At the follow-up, both groups showed an improvement in most clinical variables, whereas only TaU + MIND patients showed a significant headache frequency reduction (p = 0.028). After one year, TaU + MIND patients showed greater SN functional connectivity with the left posterior insula (p-FWE = 0.007) and sensorimotor cortex (p-FWE = 0.026). In TaU + MIND patients only, greater SN-insular connectivity was associated with improved depression scores (r = -0.51, p = 0.038). A longitudinal increase in cortical thickness was observed in the insular cluster in these patients (p = 0.015). Increased anterior cingulate cortex thickness was also reported in TaU + MIND group (p-FWE = 0.02).
CONCLUSIONS
Increased SN-insular connectivity might modulate chronic pain perception and the management of negative emotions. Enhanced SN-sensorimotor connectivity could reflect improved body-awareness of painful sensations. Expanded cingulate cortex thickness might sustain improved cognitive processing of nociceptive information. Our findings unveil the therapeutic potential of mindfulness and the underlying neural mechanisms in CM-MOH patients.
TRIAL REGISTRATION
Name of Registry; MIND-CM study; Registration Number ClinicalTrials.gov identifier: NCT0367168; Registration Date: 14/09/2018.
Topics: Humans; Mindfulness; Headache Disorders, Secondary; Female; Male; Adult; Middle Aged; Longitudinal Studies; Single-Blind Method; Magnetic Resonance Imaging; Default Mode Network; Cerebral Cortex
PubMed: 38858629
DOI: 10.1186/s10194-024-01803-5 -
Nature Ecology & Evolution Jun 2024Personal names are a universal feature of human language, yet few analogues exist in other species. While dolphins and parrots address conspecifics by imitating the...
Personal names are a universal feature of human language, yet few analogues exist in other species. While dolphins and parrots address conspecifics by imitating the calls of the addressee, human names are not imitations of the sounds typically made by the named individual. Labelling objects or individuals without relying on imitation of the sounds made by the referent radically expands the expressive power of language. Thus, if non-imitative name analogues were found in other species, this could have important implications for our understanding of language evolution. Here we present evidence that wild African elephants address one another with individually specific calls, probably without relying on imitation of the receiver. We used machine learning to demonstrate that the receiver of a call could be predicted from the call's acoustic structure, regardless of how similar the call was to the receiver's vocalizations. Moreover, elephants differentially responded to playbacks of calls originally addressed to them relative to calls addressed to a different individual. Our findings offer evidence for individual addressing of conspecifics in elephants. They further suggest that, unlike other non-human animals, elephants probably do not rely on imitation of the receiver's calls to address one another.
PubMed: 38858512
DOI: 10.1038/s41559-024-02420-w -
BMJ Open Jun 2024In the face of unprecedented demand, the Welsh Ambulance Services University NHS Trust developed 'Blue Light Hub': a new app to educate primary school-aged children...
"When you're hurt and you need serious help you call 999." Educating children about emergency services and appropriate use of 999: An evaluation study of the Blue Light Hub app.
OBJECTIVES
In the face of unprecedented demand, the Welsh Ambulance Services University NHS Trust developed 'Blue Light Hub': a new app to educate primary school-aged children about emergency services. Our overarching aim was to examine the effectiveness of the app.
DESIGN
Primary school-aged children from three schools in South Wales, UK, played with the app for 2 hours over 2 weeks in class time. Children completed quizzes to assess their knowledge and awareness of, and confidence in engaging with, emergency services before and after using the app.
PARTICIPANTS
Our evaluation focused on N=393 children who completed both the pre-test and post-test quizzes. On average, children were 8-9 years old (median school year, Year 4); 47.8% were male and 50.9% were female.
RESULTS
After using the app, there was a significant increase in the proportion of children who knew of appropriate actions to take in non-emergency scenarios, χ(1) = 26.01, and could provide a question a call handler would ask them if they called 999, χ(1) = 13.79. There was also an increase in the proportion of children who could identify an National Health Service (NHS) service that could help them if they were unwell, χ(1) = 33.31, name different roles in the NHS, χ(1) = 12.80 and knew how dialling 111 could help them χ(1) = 90.05 (all p values<0.001).
CONCLUSION
To our knowledge, Blue Light Hub is the first app of its kind designed to educate primary school-aged children about emergency services. Our findings provide preliminary evidence that the app supports children's knowledge and awareness of emergency services.
Topics: Humans; Child; Female; Male; Mobile Applications; Wales; Emergency Medical Services; Health Knowledge, Attitudes, Practice; Health Education; Ambulances; Blue Light
PubMed: 38858135
DOI: 10.1136/bmjopen-2023-079214 -
Biochimica Et Biophysica Acta. General... Jun 2024Mitochondria play a crucial role in maintaining Ca homeostasis in cells. Due to the critical regulatory role of the products of oxidative and non-oxidative metabolism of...
Mitochondria play a crucial role in maintaining Ca homeostasis in cells. Due to the critical regulatory role of the products of oxidative and non-oxidative metabolism of L-arginine, it is essential to clarify their effect on Ca transport in smooth muscle mitochondria. Experiments were performed on the uterine myocytes of rats and isolated mitochondria. The possibility of NO synthesis by mitochondria was demonstrated by confocal microscopy and spectrofluorimetry methods using the NO-sensitive fluorescent probe DAF-FM and Mitotracker Orange CM-H2TMRos. It was shown that 50 μM L-arginine stimulates the energy-dependent accumulation of Ca in mitochondria using the fluorescent probe Fluo-4 AM. A similar effect occurred when using nitric oxide donors 100 μM SNP, SNAP, and sodium nitrite (SN) directly. The stimulating effect was eliminated in the presence of the NO scavenger C-PTIO. Nitric oxide reduces the electrical potential in mitochondria without causing them to swell. The stimulatory effect of spermine on the accumulation of Ca by mitochondria is attributed to the enhancement of NO synthesis, which was demonstrated with the use of C-PTIO, NO-synthase inhibitors (100 μM NA and L-NAME), as well as by direct monitoring of NO synthesis fluorescent probe DAF-FM. A conclusion was drawn about the potential regulatory effect of the product of the oxidative metabolism of L-arginine - NO on the transport of Ca in the mitochondria of the myometrium, as well as the corresponding effect of the product of non-oxidative metabolism -spermine by increasing the synthesis of NO in these subcellular structures.
PubMed: 38857773
DOI: 10.1016/j.bbagen.2024.130652 -
Asian Journal of Surgery Jun 2024
PubMed: 38853115
DOI: 10.1016/j.asjsur.2024.05.209 -
Accident; Analysis and Prevention Jun 2024A two-factor experiment was devised to assess the appropriateness of the quantity and arrangement of information on multi-information guide signs at unique, spacious...
A two-factor experiment was devised to assess the appropriateness of the quantity and arrangement of information on multi-information guide signs at unique, spacious exits on elevated expressway sections. This experiment investigated 77 signs containing varying amounts of road name information and different placements of destination road names. The research entailed an indoor experiment that incorporated eye-tracking technology and involved the analysis of a total of twenty-eight indicators. A comprehensive index system was developed, identifying three key aspects: visual recognition efficiency, visual recognition difficulty, and visual fatigue. Utilizing repeated measure analysis of variances, the impact of these two factors was examined to identify significant indicators and establish a comprehensive assessment indicator system. The Technique for Order of Preference by Similarity to Ideal Solution method, in conjunction with the coefficient of entropy weight, was employed to assess the effectiveness of these two factors. The findings demonstrated that the 28 eye-movement indicators utilized in this study effectively constitute a valuable indicator system for evaluating drivers' visual recognition characteristics. These indicators capture the subtle psychophysical traits inherent in the process of recognizing signs, including visual recognition efficiency, difficulty, and fatigue. Regarding the first experimental factor, the number of sign road names significantly influences drivers' visual recognition characteristics (Sig < 0.05). Specifically, an increase in the number of sign road names leads to diminished visual recognition efficiency and heightened visual recognition difficulty and fatigue. Consequently, it is advisable to restrict the number of sign road names to a maximum of six per sign under typical circumstances, with nine being the limit under special conditions. As for the second experimental factor, the placement of the destination road name within the sign layout exerts a significant impact on visual recognition characteristics (Sig < 0.05). Each type of multi-information sign exhibits a distinct visual recognition pattern. Generally, the upper portion of the sign is more easily recognized, while the lower part poses greater recognition challenges. Therefore, to mitigate visual recognition risks, it is recommended that road information placement be prioritized based on actual usage conditions.
PubMed: 38852222
DOI: 10.1016/j.aap.2024.107637 -
Best Practice & Research. Clinical... Jun 2024Juvenile Idiopathic Arthritis (JIA) is sometimes considered a diagnosis of exclusion as the name signifies that no cause is evident for this form of arthritis. Despite... (Review)
Review
Juvenile Idiopathic Arthritis (JIA) is sometimes considered a diagnosis of exclusion as the name signifies that no cause is evident for this form of arthritis. Despite this JIA has some classical clinical features and many categories are defined based on the phenotype. Since there is no diagnostic test for JIA, diseases that can mimic JIA, including Primary Immunodeficiencies (PID) can sometimes be misdiagnosed as JIA. The clues to suspecting PIDs are early age of onset, presence of family history, increased susceptibility to infections, unusual features like urticaria, interstitial lung disease, sensorineural hearing loss and poor response to conventional therapy, amongst others. This review will highlight the basics of PIDs and will discuss PIDs that can present with arthritis and hence can be confused with JIA.
PubMed: 38851969
DOI: 10.1016/j.berh.2024.101960 -
PloS One 2024Neuroimaging studies have shown that activity in the prefrontal cortex correlates with two critical aspects of normal memory functioning: retrieval of episodic memories...
Neuroimaging studies have shown that activity in the prefrontal cortex correlates with two critical aspects of normal memory functioning: retrieval of episodic memories and subjective "feelings-of-knowing" about our memory. Brain stimulation can be used to test the causal role of the prefrontal cortex in these processes, and whether the role differs for the left versus right prefrontal cortex. We compared the effects of online High-Definition transcranial Direct Current Stimulation (HD-tDCS) over the left or right dorsolateral prefrontal cortex (DLPFC) compared to sham during a proverb-name associative memory and feeling-of-knowing task. There were no significant effects of HD-tDCS on either associative recognition or feeling-of-knowing performance, with Bayesian analyses showing moderate support for the null hypotheses. Despite past work showing effects of HD-tDCS on other memory and feeling-of-knowing tasks, and neuroimaging showing effects with similar tasks, these findings add to the literature of non-significant effects with tDCS. This work highlights the need to better understand factors that determine the effectiveness of tDCS, especially if tDCS is to have a successful future as a clinical intervention.
Topics: Humans; Transcranial Direct Current Stimulation; Male; Female; Adult; Young Adult; Dorsolateral Prefrontal Cortex; Memory; Bayes Theorem; Adolescent; Prefrontal Cortex
PubMed: 38848375
DOI: 10.1371/journal.pone.0300779