The Evaluation of the Relationship between Racial Health Disparities and the Patient-Provider Relationship

African Americans are adversely affected by health disparities due to the complexities of the patient-provider relationship. The behavioral model of health services was used as the theoretical framework to understand how individuals make healthcare utilization decisions. The purpose of the research was to evaluate how the patient-provider relationship influences inconsistent doctor visits by African American patients despite the prevalence of chronic conditions. 45 African Americans located in Shelby County, Tennessee were included in this study. A cross-sectional quantitative design was used to collect the data via an online survey. The 45 collected responses were analyzed by performing multiple linear regression, Pearson correlation, and Cronbach\u27s ï?¡. Results of the analyses were statistically significant in proving that education level, income, gender of African Americans, and having health insurance affect the patient-provider relationship. It was determined by the statistically significant results that the patient-provider relationship had an effect on African American patients\u27 decision to seek healthcare services and medication compliance and follow-up medical care. This information may guide the conversation within the Shelby County, Tennessee African American community regarding what role the patient-provider relationship has when addressing health disparities among African Americans

Matrix metalloproteinase activities and their relationship with collagen remodelling in tendon pathology

Our aim was to correlate the activity of matrix metalloproteinases (MMPs) with denaturation and the turnover of collagen in normal and pathological human tendons. MMPs were extracted from ruptured supraspinatus tendons (n=10), macroscopically normal (‘control’) supraspinatus tendons (n=29) and normal short head of biceps brachii tendons (n=24). Enzyme activity was measured using fluorogenic substrates selective for MMP-1, MMP-3 and enzymes with gelatinolytic activity (MMP-2, MMP-9 and MMP-13). Collagen denaturation was determined by a-chymotrypsin digestion. Protein turnover was determined by measuring the percentage of d-aspartic acid (% d-Asp). Zymography was conducted to identity specific gelatinases. MMP-1 activity was higher in ruptured supraspinatus compared to control supraspinatus and normal biceps brachii tendons (70.9, 26.4 and 11.5 fmol/mg tendon, respectively;

Walking The Walk: How The Theory Of Reasoned Action Explains Adult And Student Intentions To Go Green

This research paper applies the Theory of Reasoned Action (TRA) to the growing trend of consumers going green. The study includes a survey informed by the TRA to show how attitudes and beliefs influence intention and behavior. The survey was administered to two samples consisting of 202 adult non-student participants and 302 undergraduate business students in the northeastern United States. The findings indicate differences in green and non-green consumer behavior between the student and adult respondents. The findings support the hypothesis that green consumption intentions affect actual green consumption behavior. The findings show how nuances occur between measures of attitudes, subjective norms, and intention. The article concludes with insights for planning effective policy and firm-level marketing strategies to encourage consumer-green thinking, feeling, and acting

Evaluation of Tumor Necrosis Factor Alpha In Sleep-Deprived Menopausal- Induced Rats and The Impact On Bone Health

Post-menopausal osteoporosis as a consequence of estrogen depletion is a growing concern for women in the United States. As more women take on executive positions and experience sleep deprivation, there is the potential for up regulation of pro-inflammatory cytokines, such as tumor necrosis factor alpha. It follows that the homeostatic imbalance of osteoclastic and osteoblastic activity leads to a greater risk of disease. Bisphosphonates generally, and Zolendronate specifically works by decreasing the number of osteoclasts. This current study investigated the impact of Zolendronate on the concentrations of tumor necrosis factor alpha-type (TNFɑ) in 32 ovariectomized Wistar rats. Throughout a five week period of sleep deprivation cycles, the concentrations of TNFɑ were collected and examined. It was originally hypothesized that the sleep deprived group of rats would have the highest concentration of TNFɑ due to the biological stress associated with insomnia. However, TNFɑ levels were significantly higher in the Zolendronate group than both the control and sleep deprived groups, as well as the sleep deprived with Zolendronate groups (p\u3c0.01). We ascribe this to bisphosphonate induced transient fever seen in Zolendronate usage in previous studies (Zicuonzo, 2003). It is also suspected that the low concentrations of TNFɑ in the sleep deprived groups are seen due to the short time frame of this experiment along with a challenged immune system in the animals. With a longer period of sleep deprivation, it is possible that the hypothesized cytokine levels would be reached

The Effects of Chronic Sleep Deprivation on Tumor Necrosis Factor Alpha and Bone Strength in Menopausal Rats

Osteoporosis affects one in four post-menopausal women, and approximately one in three of those women will experience a fracture due to osteoporosis in their lifetime. Sleep deprivation may be a contributing factor in the acceleration of osteoporosis due to the increase in pro-inflammatory cytokine production which may potentiate the diminished estrogen signaling. Tumor-necrosis factor alpha-type (TNFα), a pro-inflammatory cytokine of interest, stimulates osteoprotegerin ligand (OPGL) to increase the degradation of bone. Bisphosphonates, like Zolendronate, are the most commonly prescribed treatment for osteoporosis because they decrease osteoclastic activity. This study analyzed the effects of chronic sleep deprivation and Zolendronate on TNFα concentration and relative bone strength of thirty-two ovariectomized Wistar rats in a five-week protocol; groups included control (C), sleep deprived (SD), sleep deprived with Zolendronate (SDZ), and Zolendronate (Z). TNFα concentrations were determined by enzyme-linked immunoassay and bone strength was determined by a three-point bending test. The calculated TNFα concentration values for the groups were: C (M=23.97 pg/mL, =1.87 pg/mL), SD (M=25.56 pg/mL, =2.56 pg/mL), SDZ (M=24.02 pg/mL, =2.17 pg/mL), and Z (M=27.26 pg/mL, =2.22 pg/mL). The calculated bone strength values for the groups followed: C (M=161.42 N, =19.37 N), SD (M=162.21 N, =24.29 N), SDZ (M=165.97 N, =22.61 N), and Z (M=156.44 N, =20.46 N). There were significant differences (p \u3c .01) in serum concentration of TNFα in the group taking Zolendronate, but we found no differences in bone strength between the groups – but the trends suggest that in larger sample sizes, differences would emerge. We believe that further research measuring the changes in cytokine concentration throughout a longer sleep deprivation protocol would be a fruitful

Trauma induced coagulopathy is limited to only one out of four shock induced endotheliopathy (SHINE) phenotypes among moderate-severely injured trauma patients: an exploratory analysis

Background: Trauma induced coagulopathy remains to be an important cause of high transfusion requirements and mortality and shock induced endotheliopathy (SHINE) has been implicated. Methods: European multicenter observational study of adult trauma patients with injury severity score ≥ 16 arriving within 2 h from injury to the trauma centers. Admission blood samples obtained were used for analysis of the SHINE biomarkers (syndecan-1, soluble thrombomodulin, adrenaline) and extensive analysis of coagulation, -and fibrinolytic factors together with collection of clinical data. Hierarchical clustering of the SHINE biomarkers was used to identify the SHINE phenotypes. Results: The 313 patients clustered into four SHINE phenotypes. Phenotype 2, having the highest glycocalyx shedding, encompassing 22% of the whole cohort, had severe coagulopathy with lower levels of prothrombin, FV, IX, X, XI and severe hyperfibrinolysis with higher plasmin – alpha 2-antiplasmin (PAP) – and tPA levels and lower alpha2 – antiplasmin levels. This phenotype had significantly higher transfusion requirements and higher mortality (39% vs. 23%, 15% and 14%) but similar injury severity score (ISS) compared to the others phenotypes. Conclusions: Hierarchical clustering identified four SHINE phenotype in a cohort of trauma patients. Trauma induced coagulopathy was confined to only one of the SHINE phenotypes, encompassing 22% of the total cohort. This phenotype was characterized by severe hypocoagulability and hyperfibrinolysis, which translated to significantly higher transfusion requirements and higher mortality compared to the other SHINE phenotypes with similar injury severity, warranting further investigation

real world effectiveness and safety of glecaprevir pibrentasvir for the treatment of patients with chronic hcv infection a meta analysis

Abstract Background and Aims Glecaprevir/pibrentasvir is approved for treating adults infected with hepatitis C virus (HCV) genotypes 1–6. In clinical trials, glecaprevir/pibrentasvir was associated with high rates of sustained virologic response at post-treatment Week 12 (SVR12) and was well tolerated. A systematic review and meta-analysis of the real-world effectiveness and safety of glecaprevir/pibrentasvir were undertaken. Methods Real-world studies reporting SVR12 in adults with HCV infection (N≥20) treated with glecaprevir/pibrentasvir were identified in journal publications from January 1, 2017, to February 25, 2019, and congress presentations through April 14, 2019. Random-effects meta-analysis was used to determine SVR12 rates using data from ≥2 cohorts; intention-to-treat (ITT) analyses included patients treated with glecaprevir/pibrentasvir who had SVR12 data available, discontinued early, or were lost to follow-up; modified ITT (mITT) analyses excluded those with non-virologic failure. Naive pooling was used to calculate adverse event (AE) rates. Results Overall, 12,531 adults were treated with glecaprevir/pibrentasvir (18 cohorts). Of patients with post-treatment Week 12 data, SVR12 rates were 96.7% (95% CI, 95.4–98.1) in the ITT population (n=8,583, 15 cohorts) and 98.1 % (95% CI, 97.1–99.2) in the mITT population (n=7,001, 14 cohorts). SVR12 rates were ≥95% across subgroups (HCV genotype, cirrhosis status, treatment history, treatment duration, on-label treatment, and subgroups of interest). AEs were reported in 17.7% (1,271/7,199) of patients (8 cohorts). Serious AEs were reported in 1.0% (55/5,522) of patients (6 cohorts). The most frequent AEs were pruritus, fatigue, and headache. AE-related treatment discontinuations were reported in 0.6% (33/5,595) of patients (6 cohorts). Conclusions Consistent with clinical trials, real-world evidence indicates that glecaprevir/pibrentasvir is a well-tolerated and highly effective pangenotypic treatment for a broad range of HCV-infected patients

Outcomes in patients with gunshot wounds to the brain.

Introduction:Gunshot wounds to the brain (GSWB) confer high lethality and uncertain recovery. It is unclear which patients benefit from aggressive resuscitation, and furthermore whether patients with GSWB undergoing cardiopulmonary resuscitation (CPR) have potential for survival or organ donation. Therefore, we sought to determine the rates of survival and organ donation, as well as identify factors associated with both outcomes in patients with GSWB undergoing CPR. Methods:We performed a retrospective, multicenter study at 25 US trauma centers including dates between June 1, 2011 and December 31, 2017. Patients were included if they suffered isolated GSWB and required CPR at a referring hospital, in the field, or in the trauma resuscitation room. Patients were excluded for significant torso or extremity injuries, or if pregnant. Binomial regression models were used to determine predictors of survival/organ donation. Results:825 patients met study criteria; the majority were male (87.6%) with a mean age of 36.5 years. Most (67%) underwent CPR in the field and 2.1% (n=17) survived to discharge. Of the non-survivors, 17.5% (n=141) were considered eligible donors, with a donation rate of 58.9% (n=83) in this group. Regression models found several predictors of survival. Hormone replacement was predictive of both survival and organ donation. Conclusion:We found that GSWB requiring CPR during trauma resuscitation was associated with a 2.1% survival rate and overall organ donation rate of 10.3%. Several factors appear to be favorably associated with survival, although predictions are uncertain due to the low number of survivors in this patient population. Hormone replacement was predictive of both survival and organ donation. These results are a starting point for determining appropriate treatment algorithms for this devastating clinical condition. Level of evidence:Level II

Monocarboxylate Transporter 4 (MCT4) Knockout Mice Have Attenuated 4NQO Induced Carcinogenesis; A Role for MCT4 in Driving Oral Squamous Cell Cancer

Head and neck squamous cell carcinoma (HNSCC) is the 6th most common human cancer and affects approximately 50,000 new patients every year in the US. The major risk factors for HNSCC are tobacco and alcohol consumption as well as oncogenic HPV infections. Despite advances in therapy, the overall survival rate for all-comers is only 50%. Understanding the biology of HNSCC is crucial to identifying new biomarkers, implementing early diagnostic approaches and developing novel therapies. As in several other cancers, HNSCC expresses elevated levels of MCT4, a member of the SLC16 family of monocarboxylate transporters. MCT4 is a H+-linked lactate transporter which functions to facilitate lactate efflux from highly glycolytic cells. High MCT4 levels in HNSCC have been associated with poor prognosis, but the role of MCT4 in the development and progression of this cancer is still poorly understood. In this study, we used 4-nitroquinoline-1-oxide (4NQO) to induce oral cancer in MCT4−/− and wild type littermates, recapitulating the disease progression in humans. Histological analysis of mouse tongues after 23 weeks of 4NQO treatment showed that MCT4−/− mice developed significantly fewer and less extended invasive lesions than wild type. In mice, as in human samples, MCT4 was not expressed in normal oral mucosa but was detected in the transformed epithelium. In the 4NQO treated mice we detected MCT4 in foci of the basal layer undergoing transformation, and progressively in areas of carcinoma in situ and invasive carcinomas. Moreover, we found MCT4 positive macrophages within the tumor and in the stroma surrounding the lesions in both human samples of HNSCC and in the 4NQO treated animals. The results of our studies showed that MCT4 could be used as an early diagnostic biomarker of HNSCC. Our finding with the MCT4−/− mice suggest MCT4 is a driver of progression to oral squamous cell cancer and MCT4 inhibitors could have clinical benefits for preventing invasive HNSCC

Growth, development, and phenotypic spectrum of individuals with deletions of 2q33.1 involving SATB2

SATB2-Associated syndrome (SAS) is an autosomal dominant, multisystemic, neurodevelopmental disorder due to alterations in SATB2 at 2q33.1. A limited number of individuals with 2q33.1 contiguous deletions encompassing SATB2 (ΔSAS) have been described in the literature. We describe 17 additional individuals with ΔSAS, review the phenotype of 33 previously published individuals with 2q33.1 deletions (n = 50, mean age = 8.5 ± 7.8 years), and provide a comprehensive comparison to individuals with other molecular mechanisms that result in SAS (non-ΔSAS). Individuals in the ΔSAS group were often underweight for age (20/41 = 49%) with a progressive decline in weight (95% CI = −2.3 to −1.1, p \u3c 0.0001) and height (95% CI = −2.3 to −1.0, p \u3c 0.0001) Z-score means from birth to last available measurement. ΔSAS individuals were often noted to have a broad spectrum of facial dysmorphism. A composite image of ΔSAS individuals generated by automated image analysis was distinct as compared to matched controls and non-ΔSAS individuals. We also present additional genotype–phenotype correlations for individuals in the ΔSAS group such as an increased risk for aortic root/ascending aorta dilation and primary pulmonary hypertension for those individuals with contiguous gene deletions that include COL3A1/COL5A2 and BMPR2, respectively. Based on these findings, we provide additional care recommendations for individuals with ΔSAS variants