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Journal of Surgical Case Reports Apr 2024Keloid is a burdensome condition that negatively affects patient's quality of life. It is influenced by a spectrum of risk factors, including tension. We propose an...
Keloid is a burdensome condition that negatively affects patient's quality of life. It is influenced by a spectrum of risk factors, including tension. We propose an approach to address the tension-free closure and optimize surgical outcomes in neck keloid. A retrospective review of neck keloid patients who underwent surgical treatment between 2014 and 2022 was performed. Five patients underwent surgical interventions. Two patients had sufficient and three had insufficient tissue redundancy. The former underwent keloid excision with tension-free closure. The latter underwent keloid excision with full thickness skin graft for tension-free closure. One patient required re-excision with free flap coverage. All patients received postoperative low dose radiation. All patients were satisfied with the results and there were no signs of keloid recurrence during the follow-up period. Tension during closure following keloid excision is a modifiable risk factor. An appropriate algorithm providing tension-free closure can minimize the recurrence.
PubMed: 38605696
DOI: 10.1093/jscr/rjae222 -
PloS One 2024This study investigates whether publicly funded summer school programs in secondary education are of substantive meaning for the math performance of students from lower...
This study investigates whether publicly funded summer school programs in secondary education are of substantive meaning for the math performance of students from lower socioeconomic backgrounds. More specifically, we explore whether this is the case when the summer programs are not explicitly aimed at low-SES students. In this context, we investigate whether summer schools in the Netherlands can decrease inequalities of opportunities in education. We use administrative data from Dutch secondary schools. To analyse the effect of the intervention we apply a Difference-in-Difference analysis in combination with matching estimation techniques. The results indicate that there is an overall modest effect of participation in a summer school. When analysing the SES groups separately, we observe a positive effect of participation for all three SES groups. However, the effect seems less strong for participants in the lowest and middle SES group compared to the highest SES group.
Topics: Humans; Schools; Ethnicity; Students; Netherlands
PubMed: 38603721
DOI: 10.1371/journal.pone.0302060 -
JMIRx Med Apr 2024To address the pandemic, the Defense Health Agency (DHA) expanded its TRICARE civilian provider network by 30.1%. In 2022, the DHA Annual Report stated that TRICARE's...
BACKGROUND
To address the pandemic, the Defense Health Agency (DHA) expanded its TRICARE civilian provider network by 30.1%. In 2022, the DHA Annual Report stated that TRICARE's provider directories were only 80% accurate. Unlike Medicare, the DHA does not publicly reveal National Provider Identification (NPI) numbers. As a result, TRICARE's 9.6 million beneficiaries lack the means to verify their doctor's credentials. Since 2013, the Department of Health and Human Services' (HHS) Office of Inspector General (OIG) has excluded 17,706 physicians and other providers from federal health programs due to billing fraud, neglect, drug-related convictions, and other offenses. These providers and their NPIs are included on the OIG's List of Excluded Individuals and Entities (LEIE). Patients who receive care from excluded providers face higher risks of hospitalization and mortality.
OBJECTIVE
We sought to assess the extent to which TRICARE screens health care provider names on their referral website against criminal databases.
METHODS
Between January 1-31, 2023, we used TRICARE West's provider directory to search for all providers within a 5-mile radius of 798 zip codes (38 per state, ≥10,000 residents each, randomly entered). We then copied and pasted all directory results' first and last names, business names, addresses, phone numbers, fax numbers, degree types, practice specialties, and active or closed statuses into a CSV file. We cross-referenced the search results against US and state databases for medical and criminal misconduct, including the OIG-LEIE and General Services Administration's (GSA) SAM.gov exclusion lists, the HHS Office of Civil Rights Health Insurance Portability and Accountability Act (HIPAA) breach reports, 15 available state Medicaid exclusion lists (state), the International Trade Administration's Consolidated Screening List (CSL), 3 Food and Drug Administration (FDA) debarment lists, the Federal Bureau of Investigation's (FBI) list of January 6 federal defendants, and the OIG-HHS list of fugitives (FUG).
RESULTS
Our provider search yielded 111,619 raw results; 54 zip codes contained no data. After removing 72,156 (64.65%) duplicate entries, closed offices, and non-TRICARE West locations, we identified 39,463 active provider names. Within this baseline sample group, there were 2398 (6.08%) total matches against all exclusion and sanction databases, including 2197 on the OIG-LEIE, 2311 on the GSA-SAM.gov list, 2 on the HIPAA list, 54 on the state Medicaid exclusion lists, 69 on the CSL, 3 on the FDA lists, 53 on the FBI list, and 10 on the FUG.
CONCLUSIONS
TRICARE's civilian provider roster merits further scrutiny by law enforcement. Following the National Institute of Standards and Technology 800, the DHA can mitigate privacy, safety, and security clearance threats by implementing an insider threat management model, robust enforcement of the False Claims Act, and mandatory security risk assessments. These are the views of the author, not the Department of Defense or the US government.
PubMed: 38602314
DOI: 10.2196/52198 -
Frontiers in Pain Research (Lausanne,... 2024
PubMed: 38596258
DOI: 10.3389/fpain.2024.1400548 -
The Journal of Physical Chemistry. C,... Apr 2024Heat is an inexhaustible source of energy, and it can be exploited by thermoelectronics to produce electrical power or electrical responses. The search for a low-cost...
Heat is an inexhaustible source of energy, and it can be exploited by thermoelectronics to produce electrical power or electrical responses. The search for a low-cost thermoelectric material that could achieve high efficiencies and can also be straightforwardly scalable has turned significant attention to the halide perovskite family. Here, we report the thermal voltage response of bismuth-based perovskite derivates and suggest a path to increase the electrical conductivity by applying chalcogenide doping. The films were produced by drop-casting or spin coating, and sulfur was introduced in the precursor solution using bismuth triethylxanthate. The physical-chemical analysis confirms the substitution. The sulfur introduction caused resistivity reduction by 2 orders of magnitude, and the thermal voltage exceeded 40 mV K near 300 K in doped and undoped bismuth-based perovskite derivates. X-ray diffraction, Raman spectroscopy, and grazing-incidence wide-angle X-ray scattering were employed to confirm the structure. X-ray photoelectron spectroscopy, elemental analysis, scanning electron microscopy, and energy-dispersive X-ray spectroscopy were employed to study the composition and morphology of the produced thin films. UV-visible absorbance, photoluminescence, inverse photoemission, and ultraviolet photoelectron spectroscopies have been used to investigate the energy band gap.
PubMed: 38595774
DOI: 10.1021/acs.jpcc.3c06324 -
Sports Medicine - Open Apr 2024Sleep and physical performance are strongly related and mutually influence each other. Athletes, particularly in disciplines like offshore sailing and ultra-endurance...
BACKGROUND
Sleep and physical performance are strongly related and mutually influence each other. Athletes, particularly in disciplines like offshore sailing and ultra-endurance sports, often suffer from sleep deprivation due to factors like irregular training times, travel, and the extended duration of events like 100-mile mountain races. Despite growing interest in sleep's role in sports science, few studies have specifically investigated the sleep patterns of ultramarathon runners. This study aimed to investigate sleep patterns and sleep management strategies in ultramarathons, and the repercussions of sleep deprivation during and after races.
METHODS
This cross-sectional study using e-survey was conducted on 1154 runners from two ultramarathons (a 165 km race with 9,576 m positive elevation; 2018 finish time [23:18:48-66:04:00], and a 111 km race with 6,433 m elevation; [15:34:56 - 41:54:16]).
RESULTS
The results revealed that 58% of the runners reported implementing sleep management strategies before or during the race. Most runners began the race with some level of sleep debt (-50 min a week before the race). During the races, 77% of runners slept, with the cumulative sleep duration varying based on race duration and the number of nights spent on the race (76 min at 165 km and 27 min at 111 km). Short naps lasting less than 30 min were the most popular strategy. The prevalence of symptoms attributed to sleep deprivation during the race was high (80%), with reported falls and hallucinations. After the race, runners reported recovering a normal state of wakefulness relatively quickly (within two days); 22% believed that sleep deprivation during the race increased the risk of accidents in everyday life.
CONCLUSION
This study provides valuable insights into sleep patterns and strategies in ultramarathon running and emphasizes the importance of adequate sleep management for performance and post-race recovery.
PubMed: 38589752
DOI: 10.1186/s40798-024-00704-w -
BMC Microbiology Apr 2024Q fever, a worldwide-occurring zoonotic disease, can cause economic losses for public and veterinary health systems. Vaccines are not yet available worldwide and...
Q fever, a worldwide-occurring zoonotic disease, can cause economic losses for public and veterinary health systems. Vaccines are not yet available worldwide and currently under development. In this regard, it is important to produce a whole cell antigen, with preserved structural and antigenic properties and free of chemical modifications. Thus, inactivation of Coxiella burnetii with ultraviolet light C (UVC) was evaluated. C. burnetii Nine Mile phase I (NMI) and phase II (NMII) were exposed to decreasing intensities in a time-dependent manner and viability was tested by rescue cultivation in axenic medium or cell culture. Effects on the cell structure were visualized by transmission electron microscopy and antigenicity of UVC-treated NMI was studied by immunization of rabbits. NMI and NMII were inactivated at UVC intensities of 250 µW/cm for 5 min or 100 µW/cm for 20 min. Reactivation by DNA repair was considered to be unlikely. No morphological changes were observed directly after UVC inactivation by transmission electron microscopy, but severe swelling and membrane degradation of bacteria with increasing severity occurred after 24 and 48 h. Immunization of rabbits resulted in a pronounced antibody response. UVC inactivation of C. burnetii resulted in a structural preserved, safe whole cell antigen and might be useful as antigen for diagnostic purposes or as vaccine candidate.
Topics: Animals; Rabbits; Coxiella burnetii; Q Fever; Vaccines
PubMed: 38575865
DOI: 10.1186/s12866-024-03246-z -
The American Journal of Tropical... May 2024Uninterrupted availability of vaccines requires a robust vaccine supply chain and logistics system (VSCLS). With special focus on remote and underserved settings, we...
Uninterrupted availability of vaccines requires a robust vaccine supply chain and logistics system (VSCLS). With special focus on remote and underserved settings, we assessed the reach and bottlenecks of the Ethiopian VSCLS after the initiation of the last mile transition. We explored the perspectives of key stakeholders using a qualitative phenomenological study. More than 300 in-depth interviews and 22 focus group discussions were conducted. The study was sequentially implemented over two phases to understand the bottlenecks at national and regional (Phase I) and lower (Phase II) levels. After the transition, the Ethiopian Pharmaceutical Supply Service started supplying vaccines directly to health facilities, bypassing intermediaries. The transition reduced supply hiccups and enabled the health sector to focus on its core activities. However, in remote areas, achievements were modest, and health facilities have been receiving supplies indirectly through district health offices. By design, health posts collect vaccines from health centers, causing demotivation of health extension workers and frequent closure of health posts. Challenges of the VSCLS include artificial shortage due to ill forecasting and failure to request needs on time, lack of functional refrigerators secondary to scarcity of skilled technicians and spare parts, and absence of dependable backup power at health centers. Vaccine wastages owing to poor forecasts, negligence, and cold chain problems are common. The VSCLS has not yet sustainably embraced digital logistics solutions. The system is overstrained by frequent outbreak responses and introduction of new vaccines. We concluded that the transition has improved the VSCLS, but the reach remains suboptimal in remote areas.
Topics: Ethiopia; Humans; Vaccines; Health Facilities; Immunization Programs; Focus Groups; Qualitative Research
PubMed: 38574549
DOI: 10.4269/ajtmh.23-0622 -
Journal of the International Society of... Dec 2024Rapid regeneration after intense exercise is essential for competitive athletes. Based on this assumption, supplementation strategies, focusing on food supplements, are...
Influence of short-term chronic oral cannabidiol application on muscle recovery and performance after an intensive training protocol - a randomized double-blind crossover study.
BACKGROUND
Rapid regeneration after intense exercise is essential for competitive athletes. Based on this assumption, supplementation strategies, focusing on food supplements, are increasing to improve the recovery processes. One such supplement is cannabidiol (CBD) which is gaining more attention in competitive sports. However, the evidence is still lacking and there are no data available about the effect of a short-term chronic application.
METHODS
A three-arm double-blind cross-over study was conducted to determine the effects of two different CBD products on performance, muscle damage and inflammatory processes in well-trained athletes. In total 17 subjects took successfully part in this study. Each subject underwent the six-day, high-intensity training protocol three times. After each training session, each subject took either a placebo or a CBD product (60 mg of oil or solubilisate). Between the intervention phases, at least four weeks of washout period was conducted. Before and after the training protocols the performance capacity in countermovement jump (CMJ), back squat (BS), bench press (BP) and 1-mile run were measured and biomarkers for muscle damage (creatine kinase, myoglobin), inflammatory processes (interleukin 6 and 10) and immune cell activity (ratios of neutrophil granulocytes, lymphocytes and, platelets) were analyzed. For statistical analyses, the current version of R and a linear mixed model was used.
RESULTS
It could identify different effects of the training protocol depending on performance level (advanced or highly advanced athletes) ( < .05). Regardless of the performance level, muscle damage and a reduction in performance could be induced by the training protocol. Only CBD oil was associated with a reduction in myoglobin concentration ( < .05) in advanced athletes. Concerning immune activity, a significant decrease in platelets lymphocyte ratios was observed in advanced athletes after placebo treatment ( < .05). CBD oil application showed a slight inhibitory effect ( < .10). Moreover, the reduction in performance differs between the performance levels. A significant decrease in CMJ was observed in advanced athletes and a decreasing trend in BS was observed in highly advanced athletes after placebo treatment ( < 0.10). Both CBD products do not affect performance parameters. For inflammatory parameters, no effects were observed.
CONCLUSION
It was found that the performance level of the subjects was a decisive factor and that they responded differently to the training protocol and the CBD application. However, no clear effects of either CBD product were found and further research is needed to identify the long-term effects of CBD application.
Topics: Humans; Cross-Over Studies; Cannabidiol; Myoglobin; Sports; Muscle, Skeletal; Athletes; Double-Blind Method; Dietary Supplements; Randomized Controlled Trials as Topic
PubMed: 38572744
DOI: 10.1080/15502783.2024.2337252 -
Infectious Diseases and Therapy Apr 2024Dolutegravir/lamivudine (DTG/3TC) was first approved by the US Food and Drug Administration in 2019 for the treatment of antiretroviral therapy (ART)-naive people with...
INTRODUCTION
Dolutegravir/lamivudine (DTG/3TC) was first approved by the US Food and Drug Administration in 2019 for the treatment of antiretroviral therapy (ART)-naive people with HIV-1 based on results from the pivotal GEMINI-1/GEMINI-2 trials. Around that time, immediate initiation of treatment upon diagnosis was recommended in the US Department of Health and Human Services guidelines. Here we report results from 126 treatment-naive people with HIV-1 who initiated DTG/3TC as part of a test-and-treat strategy (n = 61) or with high baseline viral loads (HIV-1 RNA ≥ 100,000 copies/ml; n = 16) from the TANDEM study.
METHODS
TANDEM was a US-based, retrospective chart review study that included a cohort of 126 individuals aged ≥ 18 years with no prior history of ART who initiated DTG/3TC before September 30, 2020, and had ≥ 6 months of follow-up. Test-and-treat was defined as ART initiation shortly after diagnosis without available viral load, CD4 + cell count, or HIV-1 resistance data. Outcomes included virologic suppression (HIV-1 RNA < 50 copies/ml; overall and by baseline viral load) and discontinuations. Analyses were descriptive.
RESULTS
Among 61 individuals who initiated DTG/3TC in a test-and-treat setting (median [interquartile range (IQR)] treatment duration, 1.3 [0.9-1.7] years), 57 (93%) achieved virologic suppression, and 51 (84%) remained suppressed; 1 (< 1%) individual discontinued DTG/3TC due to persistent low-level viremia. The most common healthcare provider (HCP)-reported reason for initiating DTG/3TC was avoidance of long-term toxicities among individuals in the test-and-treat subgroup. Of 16 treatment-naive individuals with high baseline viral loads (median [IQR] treatment duration, 100,000-250,000 copies/ml: 1.2 [0.8-1.8] years; > 250,000 copies/ml: 1.0 [0.7-1.1] years), 14 (88%) achieved virologic suppression, 13 (81%) remained suppressed, and none discontinued DTG/3TC. Patient preference was the most common HCP-reported reason for initiating DTG/3TC in this subgroup.
CONCLUSIONS
Results demonstrate real-world effectiveness of DTG/3TC, with few discontinuations, in people with HIV-1 in test-and-treat settings or with high baseline viral loads.
PubMed: 38570444
DOI: 10.1007/s40121-024-00950-1