Is Media Coverage of Steroids On The Verge Of Striking Out Baseball Stars?

Over the last 150 years, baseball has been one of the most popular American sports. Ever since its inception in the 19th century, it has been known as our “Great American Past-Time”. As the sport of baseball has evolved and developed into the game it is today, there have been controversial scandals that have helped reshape our perceptions of baseball’s biggest stars

Using the Reverse Case Study to Meet Clinical Outcomes in a Practice-Based Discipline

The coronavirus (COVID-19) has disrupted curricular plans at UNLV and nursing schools across the nation, and clinical instruction and evaluation were notably impacted. Nursing faculty are accustomed to direct observation of student performance in the clinical setting to inform student evaluation in clinical. Due to the pandemic, many clinical requirements are completed virtually because of clinical displacement of students. With reverse case study use in a remote clinical learning environment, the UNLV SoN has successfully met clinical learning needs during the COVID-19 pandemic. Reverse case studies differ from the traditional case study in that students are involved with the development or evolution of the patient case. Combining this instructional method with the remote learning environment has been successful in our clinical courses at the SoN. It has been paramount in preventing disruption in our nursing students\u27 journey toward becoming professional nurses and joining the force in combating COVID-19. Traditional methods of observing and evaluating students were interrupted by the COVID-19 pandemic. Reverse case studies allowed the clinical instructor and group to work closely together, allowing the instructor to evaluate critical thinking, collaboration and teamwork, prioritization, clinical judgment, and decision-making. Clinical instructor evaluations, both formal and informal, rendered results that showed an increase in all of the noted areas. Student feedback regarding the use of reverse case studies was positive, resulting in qualitative feedback such as, I enjoyed the reverse case studies. They made me think, I enjoyed working with my group members to solve the patients\u27 case-I felt like a nurse,” and The reverse case studies allowed me to practice clinical decision making. Faculty at the SON have developed guidelines and templates based on evidence-based resources that can be shared with other schools who want to try this approach. Other practice-based disciplines can use this method of instruction in the remote clinical learning environment and using adapted versions of our guidelines and templates. Using a webconferencing platform such as Zoom or Google Hang-Outs, clinical instructors can create an environment simulating actual patient cases driven by students.https://digitalscholarship.unlv.edu/btp_expo/1130/thumbnail.jp

Psychological violence and manipulative behavior in couple: A focus on personality traits

Psychological violence is characterized by systematic denigration and humiliation of the partner (victim). It is an insidious and manipulative behavior put in place to ensure that the victim begins to doubt themselves, and their own judgments, to the point of feeling confused and wrong. This behavior pattern is called Gaslighting and the personality traits are characterized by lack of empathy, psychopathy, narcissism and Machiavellianism. These three conditions are part of the so-called dark triad and distinguished by the lack of empathy. The aim of this study is to explore psychological aspects and consequences of Gaslighting phenomena. This systematic review was conducted according to Systematic Reviews guidelines (PubMed and Google Scholar databases), using 2 key terms related to this topic “Psychological Violence” AND “Gaslighting”. Data for this systematic review were collected in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The reviewed studies focused on violence on affective manipulation, abuse trauma that compromises a subject\u27s identity, psyche, self-esteem and sense of self, in women\u27s mental health conditions. Most of the research analyzed is focused on the gender violence and manipulative behavior in couples

Robotic bronchoscopy for peripheral pulmonary lesions: A multicenter pilot and feasibility study (BENEFIT)

BACKGROUND: The diagnosis of peripheral pulmonary lesions (PPL) continues to present clinical challenges. Despite extensive experience with guided bronchoscopy, the diagnostic yield has not improved significantly. Robotic-assisted bronchoscopic platforms have been developed potentially to improve the diagnostic yield for PPL. Presently, limited data exist that evaluate the performance of robotic systems in live human subjects. RESEARCH QUESTION: What is the safety and feasibility of robotic-assisted bronchoscopy in patients with PPLs? STUDY DESIGN AND METHODS: This was a prospective, multicenter pilot and feasibility study that used a robotic bronchoscopic system with a mother-daughter configuration in patients with PPL 1 to 5 cm in size. The primary end points were successful lesion localization with the use of radial probe endobronchial ultrasound (R-EBUS) imaging and incidence of procedure related adverse events. Robotic bronchoscopy was performed in patients with the use of direct visualization, electromagnetic navigation, and fluoroscopy. After the use of R-EBUS imaging, transbronchial needle aspiration was performed. Rapid on-site evaluation (ROSE) was used on all cases. Transbronchial needle aspiration alone was sufficient when ROSE was diagnostic; when ROSE was not diagnostic, transbronchial biopsy was performed with the use of the robotic platform, followed by conventional guided bronchoscopic approaches at the discretion of the investigator. RESULTS: Fifty-five patients were enrolled at five centers. One patient withdrew consent, which left 54 patients for data analysis. Median lesion size was 23 mm (interquartile range, 15 to 29 mm). R-EBUS images were available in 53 of 54 cases. Lesion localization was successful in 51 of 53 patients (96.2%). Pneumothorax was reported in two of 54 of the cases (3.7%); tube thoracostomy was required in one of the cases (1.9 %). No additional adverse events occurred. INTERPRETATION: This is the first, prospective, multicenter study of robotic bronchoscopy in patients with PPLs. Successful lesion localization was achieved in 96.2% of cases, with an adverse event rate comparable with conventional bronchoscopic procedures. Additional large prospective studies are warranted to evaluate procedure characteristics, such as diagnostic yield. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT03727425; URL: www.clinicaltrials.gov

An Intensive Course: Benefits for Non-Traditional Students in a Practice-Based Discipline

Intensive courses: compressed, condensed, or accelerated courses deliver content within a shortened period of time. An intensive course is not meant to be a copy and paste of a traditional full-semester course. Students will: Meet more frequently for a shorter period of time for class activities, discussions, and group work. Have increased number of out-of-class, self-study commitment hours for pre intensive course preparation. Intensive courses provide a different modality to the higher educational environment. Non-traditional students, such as second-degree-seeking, desire to return to school while keeping pace with their daily responsibilities and therefore require non-traditional methods of instruction. This type of course delivery allows for easier access and integration into daily life than traditional course delivery. Intensive courses: Maximize adult learning opportunities to achieve course outcomes in a condensed time frame Use measurements that assess multiple outcomes and objectives Since there is an increase in enrollment of non-traditional students, universities are challenged to consider learning opportunities that meet the needs of non-traditional students.https://digitalscholarship.unlv.edu/btp_expo/1164/thumbnail.jp

Safety and diagnostic performance of pulmonologists performing electromagnetic guided percutaneous lung biopsy (SPiNperc)

Background and objectivePercutaneous lung biopsy for diagnostic sampling of peripheral lung nodules has been widely performed by interventional radiologists under computed tomography (CT) guidance. New technology allows pulmonologists to perform percutaneous lung biopsies using electromagnetic (EM) guided technology. With the adoption of this new technique, the safety, feasibility and diagnostic yield need to be explored. The goal of this study was to determine the safety, feasibility and diagnostic yield of EMâ guided percutaneous lung biopsy performed by pulmonologists.MethodsWe conducted a retrospective, multicentre study of 129 EMâ guided percutaneous lung biopsies that occurred between November 2013 and March 2017. The study consisted of seven academic and three community medical centres.ResultsThe average age of participants was 65.6â years, BMI was 26.3 and 50.4% were females. The majority of lesions were in the right upper lobe (37.2%) and left upper lobe (31.8%). The mean size of the lesions was 27.31â mm and the average distance from the pleura was 13.2â mm. Practitioners averaged two fineâ needle aspirates and five core biopsies per procedure. There were 23 (17.8%) pneumothoraces, of which 16 (12.4%) received smallâ bore chest tube placement. The diagnostic yield of percutaneous lung biopsy was 73.7%. When EMâ guided bronchoscopic sampling was also performed during the same procedural encounter, the overall diagnostic yield increased to 81.1%.ConclusionIn this large multicentred series, the use of EM guidance for percutaneous lung biopsies was safe and feasible, with acceptable diagnostic yield in the hands of pulmonologists. A prospective multicentre trial to validate these findings is currently underway (NCT03338049).Lung cancer screening has led to the discovery of over 1â million pulmonary nodules each year. New technology allows pulmonologists to perform percutaneous lung biopsies using electromagnetic (EM) guided technology. In this retrospective analysis, we demonstrate that EM percutaneous needle biopsy is safe, feasible and provides an acceptable diagnostic yield.See related EditorialPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149341/1/resp13471.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149341/2/resp13471_am.pd

Clinical Significance of Serum Albumin and Implications of FcRn Inhibitor Treatment in IgG-Mediated Autoimmune Disorders

Serum albumin (SA), the most abundant soluble protein in the body, maintains plasma oncotic pressure and regulates the distribution of vascular fluid and has a range of other important functions. The goals of this review are to expand clinical knowledge regarding the functions of SA, elucidate effects of dysregulated SA concentration, and discuss the clinical relevance of hypoalbuminemia resulting from various diseases. We discuss potential repercussions of SA dysregulation on cholesterol levels, liver function, and other processes that rely on its homeostasis, as decreased SA concentration has been shown to be associated with increased risk for cardiovascular disease, hyperlipidemia, and mortality. We describe the anti-inflammatory and antioxidant properties of SA, as well as its ability to bind and transport a plethora of endogenous and exogenous molecules. SA is the primary serum protein involved in binding and transport of drugs and as such has the potential to affect, or be affected by, certain medications. Of current relevance are antibody-based inhibitors of the neonatal Fc receptor (FcRn), several of which are under clinical development to treat immunoglobulin G (IgG)-mediated autoimmune disorders; some have been shown to decrease SA concentration. FcRn acts as a homeostatic regulator of SA by rescuing it, as well as IgG, from intracellular degradation via a common cellular recycling mechanism. Greater clinical understanding of the multifunctional nature of SA and the potential clinical impact of decreased SA are needed; in particular, the potential for certain treatments to reduce SA concentration, which may affect efficacy and toxicity of medications and disease progression

Toll-Like Receptor Ligands Induce Human T Cell Activation and Death, a Model for HIV Pathogenesis

Background: Recently, heightened systemic translocation of microbial products was found in persons with chronic HIV infection and this was linked to immune activation and CD4 + T cell homeostasis. Methodology: We examined here the effects of microbial Toll-like receptor (TLR) ligands on T cell activation in vitro. Conclusions/Findings: We show that exposure to TLR ligands results in activation of memory and effector CD4 + and CD8 + T cells. After exposure to each of 8 different ligands that activate TLRs 2, 3, 4, 5, 7, 8, and 9, CD8 + T cells are activated and gain expression of the C type lectin CD69 that may promote their retention in lymphoid tissues. In contrast, CD4 + T cells rarely increase CD69 expression but instead enter cell cycle. Despite activation and cell cycle entry, CD4 + T cells divide poorly and instead, disproportionately undergo activation-induced cell death. Systemic exposure to TLR agonists may therefore increase immune activation, effector cell sequestration in lymphoid tissues and T cell turnover. These events may contribute to the pathogenesis of immune dysfunction and CD4+ T cell losses in chronic infection with the human immunodeficiency virus