Ethnic and Gender Differences in Psychosocial Factors in Native Hawaiian, other Pacific Islanders, and Asian American Adults with Type 2 Diabetes

This study examined the differences between 207 Asians and Native Hawaiian, other Pacific Islanders (NHOPI) with type 2 diabetes among various psychosocial measures. Responses to five multivariable regression models including the Diabetes Quality of Life Questionnaire (DQOL) and Short Form -36® Health Survey (SF-36) were analyzed. Differences were determined by linear contrasts in the multivariate linear regression models after adjusted for multiple demographic and socioeconomic variables. Compared to Asians, NHOPIs perceived a lower impact of diabetes on their quality of life; highlighting differences in perceptions of self-efficacy and self-care activities. Females did better on their diet while males perceived better social support. Approaches to diabetes treatment decisions should include ethnic and cultural differences that may impact treatment outcomes

Acute portal venous thrombosis caused by severe sepsis and not associated with liver disease

Background: Portal venous thrombosis (PVT) can be generally classified into three categories- acute non cirrhotic PVT, chronic PVT (also called extrahepatic portal venous occlusion), and PVT in cirrhosis. PVT is usually seen in those with liver disease and it is rare in patients without. Management is usually with anticoagulation and finding and treating the etiology of the PVT. If untreated, patients can develop portal hypertension. This patient presented a unique diagnostic challenge as she had risk factors for numerous etiologies of PVT. Case description: A 64 year old female with a history of hypertension, hyperlipidemia, and a lung nodule presented to the emergency department with fatigue, fever, nausea, and vomiting. She sought medical care upon returning home from a cruise in Mexico. She was febrile and tachycardic and, though she did not have any abdominal tenderness, stated that a few days prior she did have right upper quadrant abdominal pain. CT scan with IV contrast was ordered and showed a masslike area in the anterior left hepatic lobe, acute left PVT, and enlarged porta hepatis lymph nodes. Subsequently, an MRCP was ordered as there was concern for malignancy given the CT findings which redemonstrated the left portal venous thrombosis and the mass described on the CT was further determined to be hepatic periportal edema. Shortly after presentation she was started on broad spectrum antibiotics given concern for sepsis as well as anticoagulation for the PVT. Blood cultures grew streptococcus intermedius, strepconstellatus, and eikenella corrodens. Given a dental procedure two months prior, a TEE was performed which did not show vegetation and endocarditis was ruled out. Given a family history of colon cancer she had a colonoscopy which showed diverticulosis with friable mucosa. That was ultimately thought to the be etiology of her bacteremia. Discussion: This case was interesting in that the patient had risk factors for multiple etiologies of her sepsis and PVT. She had recent dental work, recent travel on the cruise, a history of a lung nodule, family history of colon cancer, initial CT scan with concern for liver mass and possible metastatic disease. She had a thorough work up that ultimately led to the thought that her bacteremia was due to diverticular disease and her sepsis was likely the etiology of her PVT. She was placed on antibiotics for 4 weeks outpatient as well as started on oral anticoagulation with a plan for repeat imaging of the PVT at the three month mark to determine length of anticoagulation.https://scholarlycommons.henryford.com/merf2019caserpt/1095/thumbnail.jp

Improved Student Outcomes in Biological Psychology Courses Through Scaffolded Reading and Writing Assignments.

The American Psychological Association expects graduating psychology majors to be able to read and summarize complex ideas accurately, and to communicate effectively as writers. However, undergraduates often have little explicit instruction and practice in reading and summarizing academic articles, or in psychology-specific writing practices. Consequently, students’ skills as academic readers and writers often fail to meet expectations. In our large public university, writing problems were prevalent in our biological psychology classes. When asked to read and summarize primary sources, students reported that the articles were very difficult to understand, papers commonly included plagiarism, and many students withdrew from the classes. To counteract this, the instructor––first author (JG-F) consulted with an English for Academic Purposes specialist (CD-F) and we created a scaffolded series of homework assignments to help students learn how to read and summarize primary source articles. Students received guided instruction about where to find information in an article and how to take notes using their own words. To help manage the instructor’s time, she spent class time going over common errors and modeling ways to paraphrase and avoid plagiarism. A mastery approach to the homework assignments was fostered by grading several assignments on a complete/incomplete basis. Students who received the intervention had higher writing assignment grades, were more likely to persist in the classes, and were less likely to fail than those who did not receive the intervention. Most students felt that the intervention improved their ability to read and to use primary sources in their writing assignments, and thought that these skills would be transferrable to other courses

The effect of a cognitive–behavioral intervention on diet and exercise among Asian Americans and Pacific Islanders with type 2 diabetes

Type 2 diabetes accounts for 90% to 95% of all diabetic cases with Asian Americans and Pacific Islanders particularly at risk. The purpose was to assess the effects of a cognitive–behavioral intervention (CBI) on diet and exercise among Asian Americans and Pacific Islanders with type 2 diabetes. Using a double-blinded, two-arm randomized clinical trial (n = 207), data on diet and exercise were analyzed before and after a 6-week CBI. Over time, treatment group showed a decrease in kcals and increase in steps compared with control group; however, results were not statistically significant. Treatment group had lower kcals of trans-fat, saturated fat, sugar, alcohol, caffeine, and dietary fiber compared with the control group. Older subjects and females had significantly lower caloric intake (p \u3c .01). Females exercised less and took fewer steps compared with males (p \u3c .05). CBI may be effective in lowering calorie intake and increasing physical activity among Asian Americans and Pacific Islanders with type 2 diabetes. Significant differences in gender and age point to the need for individualized research and treatment targeting this group

The chemical structure and phosphorothioate content of hydrophobically modified siRNAs impact extrahepatic distribution and efficacy

Small interfering RNAs (siRNAs) have revolutionized the treatment of liver diseases. However, robust siRNA delivery to other tissues represents a major technological need. Conjugating lipids (e.g. docosanoic acid, DCA) to siRNA supports extrahepatic delivery, but tissue accumulation and gene silencing efficacy are lower than that achieved in liver by clinical-stage compounds. The chemical structure of conjugated siRNA may significantly impact invivo efficacy, particularly in tissues with lower compound accumulation. Here, we report the first systematic evaluation of the impact of siRNA scaffold-i.e. structure, phosphorothioate (PS) content, linker composition-on DCA-conjugated siRNA delivery and efficacy in vivo. We found that structural asymmetry (e.g. 5- or 2-nt overhang) has no impact on accumulation, but is a principal factor for enhancing activity in extrahepatic tissues. Similarly, linker chemistry (cleavable versus stable) altered activity, but not accumulation. In contrast, increasing PS content enhanced accumulation of asymmetric compounds, but negatively impacted efficacy. Our findings suggest that siRNA tissue accumulation does not fully define efficacy, and that the impact of siRNA chemical structure on activity is driven by intracellular re-distribution and endosomal escape. Fine-tuning siRNA chemical structure for optimal extrahepatic efficacy is a critical next step for the progression of therapeutic RNAi applications beyond liver

A Guide to Point of Care Ultrasound Evaluation of Pneumonia

A patient presenting with fever, hypoxia, productive cough, and leukocytosis can be diagnosed with pneumonia without any imaging findings. However, we often rely on X-ray and computed tomography (CT) imaging to support the clinical diagnosis. Ultrasound is an effective imaging modality for identifying pneumonia without delay and radiation risks.1,2 A meta-analysis by Ye et al. in 2015 found that ultrasound diagnosis of pneumonia had a pooled sensitivity of 0.95 and a pooled specificity of 0.9, which is superior to X-ray imaging which had a pooled sensitivity of 0.77 and a similar pooled specificity of 0.9.3 This study used CT imaging as a gold standard for comparison

A Guide to Point of Care Ultrasound Lung and IVC Examination of a Volume Overloaded Patient

A patient presents with dyspnea, hypoxia, and lower extremity edema. Their history is notable for recent high salt intake and non-compliance with diuretics, and their lungs have rales bilaterally. Clinically, we can diagnose a heart failure exacerbation with pulmonary edema. However, we often rely on X-ray and computed tomography (CT) imaging to support the clinical diagnosis and explore the etiology of the hypoxia and dyspnea to narrow the differential. Ultrasound is an effective modality for identifying pulmonary edema and pleural effusions while at the same time ruling out other etiologies such as pneumonia and pneumothorax. With bedside point of care ultrasound (POCUS), there is no radiation risk and no delay in obtaining imaging. A systematic review and meta-analysis study by Maw et al. published in 2019 found that lung ultrasound diagnosis of pulmonary edema in the setting of clinical suspicion for acute decompensated heart failure had a pooled sensitivity of 0.88 and specificity of 0.9, which is superior to X-ray imaging which demonstrated a pooled sensitivity of 0.73 and a pooled specificity of 0.9.

A Guide to Point of Care Ultrasound Examination of Acute Decompensated Heart Failure

A patient presents with dyspnea on exertion, orthopnea, and lower extremity edema. They have a prior history of coronary artery disease and reported episodes of chest pain three months ago. They did not seek medical evaluation at the time and have had no chest pain recently. In this setting, there is a high clinical suspicion of heart failure with concern for ischemic heart disease. The gold standard for diagnosis of heart failure is a formal transthoracic echocardiogram. Bedside point of care ultrasound (POCUS) is a tool that can provide essential information without delay in diagnosis

A Guide to Point of Care Ultrasound Examination of a Pericardial Effusion

A patient presents with pleuritic chest pain, dyspnea, and a recent viral illness. They have no prior cardiac or pulmonary history. Their X-ray on admission demonstrates no pulmonary findings and an enlarged cardiac silhouette, and their EKG is low voltage with electrical alternans. Ultrasound is an effective modality for identifying pericardial effusion and cardiac tamponade while at the same time evaluating for other causes, such as heart failure. Often patients with symptomatic pericardial ef fusion present with non-specific symptoms. While a “formal” transthoracic echocardiogram remains the gold standard for diagnosis, a bedside point of care ultrasound (POCUS) cardiac evaluation can significantly decrease the time to diagnosis and trigger an order for an urgent “formal” echocardiogram.1 A retrospective study by Hanson and Chan in 2021 found that POCUS led to an expedited average time to diagnosis of 5.9 hours compared to \u3e12 hours with other imaging. Those with a symptomatic pericardial effusion identified by POCUS had a significantly decreased time to treatment; time to pericardiocentesis of 28.1 hours compared to \u3e 48 hours with other diagnostic modalities.