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  • ItemOpen Access
    Perioperative Blindness in Spine Surgery: A Scoping Literature Review.
    (Journal of clinical medicine, 2024-02) Sperber, Jacob; Owolo, Edwin; Zachem, Tanner J; Bishop, Brandon; Johnson, Eli; Lad, Eleonora M; Goodwin, C Rory
    Perioperative vision loss (POVL) is a devastating surgical complication that impacts both the recovery from surgery and quality of life, most commonly occurring after spine surgery. With rates of spine surgery dramatically increasing, the prevalence of POVL will increase proportionately. This scoping review aims to aggregate the literature pertinent to POVL in spine surgery and consolidate recommendations and preventative measures to reduce the risk of POVL. There are several causes of POVL, and the main contribution following spine surgery is ischemic optic neuropathy (ION). Vision loss often manifests immediately following surgery and is irreversible and severe. Diffusion weighted imaging has recently surfaced as a diagnostic tool to identify ION. There are no effective treatments; therefore, risk stratification for counseling and prevention are vital. Patients undergoing prone surgery of long duration and/or with significant expected blood loss are at greatest risk. Future research is necessary to develop effective treatments.
  • ItemOpen Access
    Characterizing imaging radiation risk in a population of 8918 patients with recurrent imaging for a better effective dose.
    (Scientific reports, 2024-03) Ria, Francesco; Rehani, Madan M; Samei, Ehsan
    An updated extension of effective dose was recently introduced, namely relative effective dose ( Er ), incorporating age and sex factors. In this study we extended Er application to a population of about 9000 patients who underwent multiple CT imaging exams, and we compared it with other commonly used radiation protection metrics in terms of their correlation with radiation risk. Using Monte Carlo methods, Er , dose-length-product based effective dose ( EDLP ), organ-dose based effective dose ( EOD ), and organ-dose based risk index ( RI ) were calculated for each patient. Each metric's dependency to RI was assessed in terms of its sensitivity and specificity. Er showed the best sensitivity, specificity, and agreement with RI (R2 = 0.97); while EDLP yielded the lowest specificity and, along with EOD , the lowest sensitivity. Compared to other metrics, Er provided a closer representation of patient and group risk also incorporating age and sex factors within the established framework of effective dose.
  • ItemOpen Access
    Challenges in the Management of Symptomatic Fallopian Canal Meningoceles: A Multicenter Case Series and Literature Review
    (Otology & Neurotology, 2024-04) Filip, Peter; Chiang, Harry; Goldberg, Allison; Khorsandi, Azita S; Moonis, Gul; Moody Antonio, Stephanie A; Wanna, George; Cosetti, Maura
    Objective To describe the presentations, the diagnosis, our treatment approaches, and the outcomes for 11 patients with fallopian canal meningocele (FCM). Study Design: Multicenter Retrospective case series. Setting Tertiary referral centers. Patients Patients (N = 11) with radiographically or intraoperatively identified, symptomatic FCM. Interventions Surgical repair of cerebrospinal fluid (CSF) leak and meningocele versus observation. Main Outcome Measures Presentation (including symptoms, radiographic imaging, and comorbidities), management (including surgical approach, technique for packing, use of lumbar drain), clinical outcomes (control of CSF leak, meningitis, facial nerve function), and revision surgery. Results Patients presented with spontaneous CSF leak (n = 7), conductive (N = 11) and sensorineural hearing loss (n = 3), nonpositional intermittent vertigo (n = 3), headaches (n = 4), and recurrent meningitis (n = 1). Risk factors in our series included obesity (n = 4), Chiari 1 malformation (n = 1), and head trauma (n = 2). Noncontrast computed tomography of the temporal bone and magnetic resonance imaging were positive for FCM in 10 patients. Eight patients were managed surgically via a transmastoid approach (n = 4), combined transmastoid and middle fossa (N = 3), or middle fossa alone (n = 1); three were managed conservatively with observation. Postoperative complications included worsened facial nerve palsy (n = 1), recurrent meningitis (n = 1), and persistent CSF leak that necessitated revision (n = 1). Conclusions Facial nerve meningoceles are rare with variable presentation, often including CSF otorrhea. Management can be challenging and guided by symptomatology and comorbidities. Risk factors for FCM include obesity and head trauma, and Chiari 1 malformation may present with nonspecific otologic symptoms, in some cases, meningitis and facial palsy. Layered surgical repair leads to high rates of success; however, this may be complicated by worsening facial palsy.
  • ItemOpen Access
    “You Are no Darker Than I Am:” The Souls of Black Folk in Maoist China
    (PMLA (Publications of the Modern Language Association), 2023-05-31) Lai-Henderson, Selina
  • ItemOpen Access
    Nasal airway obstruction in patients with cleft lip nasal deformity: a systematic review
    (Journal of Plastic, Reconstructive & Aesthetic Surgery, 2024-02) Chiang, Harry; Shah, Reanna; Washabaugh, Claire; Frank-Ito, Dennis O
  • ItemOpen Access
    And Who is My Neighbor?: A Faith-Based Argument for Immigration Policy Reform in Welcoming Undocumented Refugees
    (Howard law journal, 2024-01-24) Augustine, Jonathan
    The January 6, 2021 insurrection in Washington, DC revealed several things about the United States. In addition to revealing that an appropriate national moniker might be the “Divided States of America,” the insurrection also showed that Christian nationalism continues to play a pervasive role in the country. Indeed, in the aftermath of vigilante protestors wearing clothing and proudly waving flags that read, “Jesus is My Savior and Trump is My President,” there has been no shortage of scholarly writings arguing that Christian nationalism is the greatest contemporary threat to American democracy. Some leading sociologists highlight that Christian nationalism—also often referenced as white Christian nationalism—might be a misnomer because it has nothing to do with theology or any religious orthodoxy. Instead, with a basis in racialized power dynamics, it is a political framework that places America on par with the Bible’s nation of Israel, regarding the original United States as manifesting God’s intention for God’s chosen people in God’s chosen land. To therefore remain consistent with America’s original power structure of white, Anglo-Saxon and Protestant dominion, Christian nationalism seeks to restore America’s order, with a particular national animus against Jews, minorities, and—to the focus of this Article—immigrants. The most recent nationalized animus against Jews has manifested with attempts to use Critical Race Theory as a wedge issue, while concurrently attempting to ban books on the Holocaust from public schools and libraries. A nationalized animus has similarly manifested against minorities—especially in the wake of the Supreme Court’s infamous decision in Shelby County v. Holder (2013)—as many Southern states have enacted voter suppression laws deliberately targeting African Americans. Indeed, in N.C State Conference of NAACP v. McCrory (2016), the U.S. Fourth Circuit Court of Appeal even found unconstitutional a law from North Carolina targeted Blacks with “almost surgical precision.” With respect to America’s failed immigration policies—especially since 2017, when the Trump Administration began with its direct appeal to Christian Nationalism through its “Make America Great Again” policies—America has taken unabashed anti-Muslim and anti-Hispanic positions. Regrettably, the succeeding Biden Administration, beginning in January 2021, has done little to reverse course. To support this Article’s central thesis, that the xenophobia of Christian nationalism must be combatted with a faith-based ethic of welcome and resistance, this Article limits its immigration policy consideration to the long-term residents I call “neighbors,” the only class of immigrants the United Nations legally classifies as refugees, displaced immigrants legally seeking refuge from another country. Indeed, refugees are largely long-term U.S. residents who have lost their resident alien status because they missed the one-year window to apply for asylum. Because of the politics of Christian nationalism, however, along with the accompanying vile rhetoric that vilifies so many hardworking members of society who contribute to the American economy, Congress has repeatedly failed to pass immigration reform legislation. Consequently, although this limited class is meaningfully contributing to America, there is no legal mechanism for these refugees to normalize their status within America. It’s time to put pressure on Congress. In looking at refugees as neighbors, this Article calls out the “Otherism” and xenophobia of Christian nationalism, while relying on the ethics of political theology in using the famed Parable of the Good Samaritan to explore “cosmopolitanism,” and “communitarianism,” two divergent social viewpoints that produce divergent immigration politics. Insofar as cosmopolitanism favors open borders, and communitarianism favors border regulation through the sovereignty of nation-states, I urge faith-based leaders to adopt a position that is a synthesis of the two, while also urging faith-based leaders to use the same scriptural ethic of civil disobedience that was so often successfully used in the past, to again fight against Christian nationalism in working toward an inclusive and egalitarian society. This Article calls on morally equipped faith leaders to initiate a rebirth of the 1980s Sanctuary Movement and serve as exemplars in placing pressure on Congress to move past gridlock and act for the good of the “Divided States.”
  • ItemOpen Access
    How Could They Let This Happen? Cover Ups, Complicity, and the Problem of Accountability
    (Res Publica, 2023-01-01) Grant, RW; Katzenstein, S; Kennedy, C
    Sexual abuse by clergymen, poisoned water, police brutality—these cases each involve two wrongs: the abuse itself and the attempt to avoid responsibility for it. Our focus is this second wrong—the cover up. Cover ups are accountability failures, and they share common strategies for thwarting accountability whatever the abuse and whatever the institution. We find that cover ups often succeed even when accountability mechanisms are in place. Hence, improved institutions will not be sufficient to prevent accountability failures. Accountability mechanisms are tools that people must be willing to use in good faith. They fail when people are complicit. What explains complicity? We identify certain human proclivities and features of modern organizations that lead people to become complicit in the wrongdoing of others. If we focus exclusively on the design of institutions, we will fail to constrain the perpetrators of wrongdoing. Understanding complicity is key to understanding accountability failures.
  • ItemOpen Access
    Investigating the Influence of Heterogeneity Within Cell Types on Microvessel Network Transport.
    (Cellular and molecular bioengineering, 2023-12) Nan, Junyu; Roychowdhury, Sayan; Randles, Amanda

    Background

    Current research on the biophysics of circulating tumor cells often overlooks the heterogeneity of cell populations, focusing instead on average cellular properties. This study aims to address the gap by considering the diversity of cell biophysical characteristics and their implications on cancer spread.

    Methods

    We utilized computer simulations to assess the influence of variations in cell size and membrane elasticity on the behavior of cells within fluid environments. The study controlled cell and fluid properties to systematically investigate the transport of tumor cells through a simulated network of branching channels.

    Results

    The simulations revealed that even minor differences in cellular properties, such as slight changes in cell radius or shear elastic modulus, lead to significant changes in the fluid conditions that cells experience, including velocity and wall shear stress (p < 0.001).

    Conclusion

    The findings underscore the importance of considering cell heterogeneity in biophysical studies and suggest that small variations in cellular characteristics can profoundly impact the dynamics of tumor cell circulation. This has potential implications for understanding the mechanisms of cancer metastasis and the development of therapeutic strategies.
  • ItemOpen Access
    Gene by stress genome-wide interaction analysis and path analysis identify EBF1 as a cardiovascular and metabolic risk gene.
    (European journal of human genetics : EJHG, 2015-06) Singh, Abanish; Babyak, Michael A; Nolan, Daniel K; Brummett, Beverly H; Jiang, Rong; Siegler, Ilene C; Kraus, William E; Shah, Svati H; Williams, Redford B; Hauser, Elizabeth R
    We performed gene-environment interaction genome-wide association analysis (G × E GWAS) to identify SNPs whose effects on metabolic traits are modified by chronic psychosocial stress in the Multi-Ethnic Study of Atherosclerosis (MESA). In Whites, the G × E GWAS for hip circumference identified five SNPs within the Early B-cell Factor 1 (EBF1) gene, all of which were in strong linkage disequilibrium. The gene-by-stress interaction (SNP × STRESS) term P-values were genome-wide significant (Ps = 7.14E-09 to 2.33E-08, uncorrected; Ps = 1.99E-07 to 5.18E-07, corrected for genomic control). The SNP-only (without interaction) model P-values (Ps = 0.011-0.022) were not significant at the conventional genome-wide significance level. Further analysis of related phenotypes identified gene-by-stress interaction effects for waist circumference, body mass index (BMI), fasting glucose, type II diabetes status, and common carotid intimal-medial thickness (CCIMT), supporting a proposed model of gene-by-stress interaction that connects cardiovascular disease (CVD) risk factor endophenotypes such as central obesity and increased blood glucose or diabetes to CVD itself. Structural equation path analysis suggested that the path from chronic psychosocial stress to CCIMT via hip circumference and fasting glucose was larger (estimate = 0.26, P = 0.033, 95% CI = 0.02-0.49) in the EBF1 rs4704963 CT/CC genotypes group than the same path in the TT group (estimate = 0.004, P = 0.34, 95% CI = -0.004-0.012). We replicated the association of the EBF1 SNPs and hip circumference in the Framingham Offspring Cohort (gene-by-stress term P-values = 0.007-0.012) as well as identified similar path relationships. This observed and replicated interaction between psychosocial stress and variation in the EBF1 gene may provide a biological hypothesis for the complex relationship between psychosocial stress, central obesity, diabetes, and cardiovascular disease.
  • ItemOpen Access
    Genome-wide analysis identifies novel susceptibility loci for myocardial infarction.
    (European heart journal, 2021-03) Hartiala, Jaana A; Han, Yi; Jia, Qiong; Hilser, James R; Huang, Pin; Gukasyan, Janet; Schwartzman, William S; Cai, Zhiheng; Biswas, Subarna; Trégouët, David-Alexandre; Smith, Nicholas L; INVENT Consortium; CHARGE Consortium Hemostasis Working Group; GENIUS-CHD Consortium; Seldin, Marcus; Pan, Calvin; Mehrabian, Margarete; Lusis, Aldons J; Bazeley, Peter; Sun, Yan V; Liu, Chang; Quyyumi, Arshed A; Scholz, Markus; Thiery, Joachim; Delgado, Graciela E; Kleber, Marcus E; März, Winfried; Howe, Laurence J; Asselbergs, Folkert W; van Vugt, Marion; Vlachojannis, Georgios J; Patel, Riyaz S; Lyytikäinen, Leo-Pekka; Kähönen, Mika; Lehtimäki, Terho; Nieminen, Tuomo VM; Kuukasjärvi, Pekka; Laurikka, Jari O; Chang, Xuling; Heng, Chew-Kiat; Jiang, Rong; Kraus, William E; Hauser, Elizabeth R; Ferguson, Jane F; Reilly, Muredach P; Ito, Kaoru; Koyama, Satoshi; Kamatani, Yoichiro; Komuro, Issei; Biobank Japan; Stolze, Lindsey K; Romanoski, Casey E; Khan, Mohammad Daud; Turner, Adam W; Miller, Clint L; Aherrahrou, Redouane; Civelek, Mete; Ma, Lijiang; Björkegren, Johan LM; Kumar, S Ram; Tang, WH Wilson; Hazen, Stanley L; Allayee, Hooman

    Aims

    While most patients with myocardial infarction (MI) have underlying coronary atherosclerosis, not all patients with coronary artery disease (CAD) develop MI. We sought to address the hypothesis that some of the genetic factors which establish atherosclerosis may be distinct from those that predispose to vulnerable plaques and thrombus formation.

    Methods and results

    We carried out a genome-wide association study for MI in the UK Biobank (n∼472 000), followed by a meta-analysis with summary statistics from the CARDIoGRAMplusC4D Consortium (n∼167 000). Multiple independent replication analyses and functional approaches were used to prioritize loci and evaluate positional candidate genes. Eight novel regions were identified for MI at the genome wide significance level, of which effect sizes at six loci were more robust for MI than for CAD without the presence of MI. Confirmatory evidence for association of a locus on chromosome 1p21.3 harbouring choline-like transporter 3 (SLC44A3) with MI in the context of CAD, but not with coronary atherosclerosis itself, was obtained in Biobank Japan (n∼165 000) and 16 independent angiography-based cohorts (n∼27 000). Follow-up analyses did not reveal association of the SLC44A3 locus with CAD risk factors, biomarkers of coagulation, other thrombotic diseases, or plasma levels of a broad array of metabolites, including choline, trimethylamine N-oxide, and betaine. However, aortic expression of SLC44A3 was increased in carriers of the MI risk allele at chromosome 1p21.3, increased in ischaemic (vs. non-diseased) coronary arteries, up-regulated in human aortic endothelial cells treated with interleukin-1β (vs. vehicle), and associated with smooth muscle cell migration in vitro.

    Conclusions

    A large-scale analysis comprising ∼831 000 subjects revealed novel genetic determinants of MI and implicated SLC44A3 in the pathophysiology of vulnerable plaques.
  • ItemOpen Access
    Identification of barriers at the primary care provider level to improve inflammatory breast cancer diagnosis and management.
    (Preventive medicine reports, 2023-12) Devi, Gayathri R; Fish, Laura J; Bennion, Alexandra; Sawin, Gregory E; Weaver, Sarah M; Reddy, Katherine; Saincher, Rashmi; Tran, Anh N
    The purpose of this study, based in the United States, was to evaluate knowledge gaps and barriers related to diagnosis and care of inflammatory breast cancer (IBC), a rare but lethal breast cancer subtype, amongst Primary Care Providers (PCP) as they are often the first point of contact when patients notice initial symptoms. PCP participants in the Duke University Health System, federally qualified health center, corporate employee health and community practices, nearby academic medical center, Duke physician assistant and advanced practice nurse leadership program alumni were first selected in a convenience sample and for semi-structured interviews (n = 11). Based on these data, an online survey tool was developed and disseminated (n = 78) to assess salient measures of IBC diagnosis, health disparity factors, referral and care coordination practices, COVID-19 impact, and continuing medical education (CME). PCP reported access to care and knowledge gaps in symptom recognition (mean = 3.3, range 1-7) as major barriers. Only 31 % reported ever suspecting IBC in a patient. PCP (n = 49) responded being challenged with referral delays in diagnostic imaging. Additionally, since the COVID-19 pandemic started, 63 % reported breast cancer referral delays, and 33 % reported diagnosing less breast cancer. PCP stated interest in CME in their practice for improved diagnosis and patient care, which included online (53 %), lunch time or other in-service training (33 %), patient and provider-facing websites (32 %). Challenges communicating rare cancer information, gaps in confidence in diagnosing IBC, and timely follow-up with patients and specialists underscores the need for developing PCP educational modules to improve guideline-concordant care.
  • ItemOpen Access
    A Southeast Asian collaborative Delphi consensus on surveying risk factors for head and neck cancer screening and prevention.
    (Global surgery (London), 2022-01) Pan, DR; Juhlin, E; Tran, AN; Wei, Q; Tang, S; Bui, AT; Iyer, NG; Lee, WT
    The objective of this study was to determine high value questions for early detection and prevention of head and neck cancer by querying content experts on patient risk factors relevant to local communities in Southeast Asia (i.e., Vietnam, Laos, China, and Singapore). The Delphi method was employed using three rounds of asynchronous surveying which included participants among five different collaborating medical centers. 60 total survey items were assessed for consensus defined by a priori measures on the relative level of value of these questions for use in head and neck cancer screening. 77% of items reached a consensus and no items were concluded to be of low value despite differences in conclusions regarding relative importance. Survey items focused on patient demographic information and physical examination were examined across variables such as expert department affiliation, academic designation, and years of experience and found to be without statistically significant differences. However, with consensus items related to social risk factors, it was determined that participants who had 15 or more years of experience or identified as otolaryngologists rated these items at a relatively lower value than their peers with less experience (p < 0.0001, p = 0.0017) or outside the field of otolaryngology (p = 0.0101). This study explicitly identifies patient variables to consider in head and neck cancer screening that have not previously been comprehensively or methodically assessed in current literature. Increasing awareness of these risk factors may benefit the design and implementation of future head and neck cancer early detection and prevention programs in Southeast Asia and beyond as well as positively impact head and neck cancer outcomes.
  • ItemOpen Access
    Design and Implementation of a Career Development Program for Physician-Scientists: Lessons Learned.
    (Urogynecology (Philadelphia, Pa.), 2022-08) Kameny, Rebecca R; Amundsen, Cindy L

    Importance

    Although skills in health services research and data science have great potential to advance the field of urogynecology, few clinical researchers obtain such training.

    Objectives

    The aim of the R25 UrogynCREST Program is to prepare the next generation of physician-scientists for a successful career in urogynecologic health services research through skilled mentoring and advanced training. The purpose of this report is to describe program implementation and lessons learned.

    Study design

    Administered through the program institution and in partnership with the American Urogynecologic Society, this program provided junior faculty with advanced online training and, through a core facility, access to health care databases for research projects. Participants received individualized mentoring and biostatistical support. Anonymous surveys captured actionable, real-time feedback from participants as they moved through the program.

    Results

    Despite a limited budget, UrogynCREST maintained a core of excellent faculty, high-quality biostatistical support, and engaged, knowledgeable advisors and mentors. This allowed for similar experiences across cohorts while permitting program improvements between cohorts in faculty-participant interactions, team dynamics, and data and regulatory support. Administrative management by a single institution facilitated responses to fiscal and regulatory changes. Asynchronized learning and partnering with a society attracted a diverse group of physician-scientists.

    Conclusions

    Career development programs that incorporate online education, mentoring, database access, and biostatistical support must be prepared for midprogram changes. Regular communication among stakeholders was vital. Working with a core facility provided efficient database access, but evolving regulatory and administrative processes and costs presented challenges. Our experiences implementing this program can benefit similar programs that train early-career physician-scientists.
  • ItemOpen Access
    Effects of Rhenium Substitution of Co and Fe in Spinel CoFe2O4 Ferrite Nanomaterials.
    (Nanomaterials (Basel, Switzerland), 2022-08) Zheng, Yuruo; Hussain, Ghulam; Li, Shuyi; Batool, Shanta; Wang, Xiawa
    In this work, nanoparticles of Co1-xRexFe2O4 and CoFe2-xRexO4 (0 ≤ x ≤ 0.05) were synthesized by the sol-gel method. The Rietveld refinement analysis of XRD and Raman data revealed that all of the prepared samples were single phase with a cubic spinel-type structure. With the substitution of Re, the lattice parameters were slightly increased, and Raman spectra peak positions corresponding to the movement of the tetrahedral sublattice shifted to a higher energy position. Furthermore, Raman spectra showed the splitting of T2g mode into branches, indicating the presence of different cations at crystallographic A- and B-sites. The SEM micrograph confirms that surface Re exchange changes the coordination environment of metals and induces Fe-site structure distortion, thereby revealing more active sites for reactions and indicating the bulk sample's porous and agglomerated morphology. The vibrating sample magnetometer (VSM) results demonstrated that the synthesized nanoparticles of all samples were ferromagnetic across the entire temperature range of 300-4 K. The estimated magnetic parameters, such as the saturation magnetization, remanent magnetization, coercivity, blocking temperature (TB), and magnetic anisotropy, were found to reduce for the Co-site doping with the increasing doping ratio of Re, while in the Fe site, they enhanced with the increasing doping ratio. The ZFC-FC magnetization curve revealed the presence of spin-glass-like behavior due to the strong dipole-dipole interactions in these ferrite nanoparticles over the whole temperature range. Finally, the dielectric constant (εr') and dielectric loss (tanδ) were sharply enhanced at low frequencies, while the AC conductivity increased at high frequencies. The sharp increases at high temperatures are explained by enhancing the barrier for charge mobility at grain boundaries, suggesting that samples were highly resistive. Interestingly, these parameters (εr', tanδ) were found to be higher for the Fe-site doping with the increasing Re doping ratio compared with the Co site.
  • ItemOpen Access
    Structural, Optical, Charge-Transport, and Dielectric Properties of Double-Perovskite La2Co1-zFezMnO6 (z = 0, 0.2-1.0).
    (Materials (Basel, Switzerland), 2022-09) Hussain, Ghulam; Batool, Shanta; Zheng, Yuruo; Li, Shuyi; Wang, Xiawa
    A series of double-perovskite La2Co1−zFezMnO6 (z = 0, 0.2−1.0) ceramics were synthesized using a well-established sol−gel method. The series of samples with a monoclinic phase and a P21/n symmetry were characterized by XRD, FTIR, conductivity, and capacitance measurement to extract charge-transport and dielectric characteristics at room temperature. The obtained IR spectra fitted well with the Lorentz oscillator model to calculate the damping factor, optical frequency, and oscillator strength and compared with the theory, which gave better agreement. The calculated activation energies from the Arrhenius plot supported the semiconducting nature of all samples. The temperature and frequency-dependent dielectric parameters, such as the real part (εr′), imaginary part (ε″) of the dielectric constant, dielectric loss (tanδ), and ac-conductivity (σac) were extracted. The dielectric constant (εr′, ε″) and dielectric loss (tanδ) were enhanced at a low frequency, while the ac-conductivity (σac) displayed higher values at higher frequencies. The enhancement in the dielectric parameters with increasing iron concentrations arose due to the higher surface volume fraction of iron (Fe3+) ions than the cobalt (Co3+) ions. The radius of the Fe3+ (0.645 Å) was relatively higher than the Co3+ ions (0.61 Å), significantly influenced by the grains and grain boundaries, and enhanced the barrier for charge mobility at the grain boundaries that play a vital role in space charge polarization.
  • ItemOpen Access
    Effect of COVID-19 on Gynecologic Oncology Care: A Survey of Practicing Gynecologic Radiation Oncologists in the United States.
    (Advances in radiation oncology, 2023-07) Brower, Jeffrey V; Rhodes, Sylvia S; Remick, Jill S; Russo, Andrea L; Dunn, Emily F; Ayala-Peacock, Diandra N; Petereit, Daniel G; Bradley, Kristin A; Taunk, Neil K

    Purpose

    The COVID-19 pandemic has placed demands and limitations on the delivery of health care. We sought to assess the effect of COVID-19 on the delivery of gynecologic oncologic care from the perspective of practicing radiation oncologists in the United States.

    Methods and materials

    An anonymous online survey was created and distributed to preidentified radiation oncologists in the United States with clinical expertise in the management of gynecologic patients. The survey consisted of demographic questions followed by directed questions to assess specific patterns of care related to the COVID-19 pandemic.

    Results

    A total of 47 of 96 invited radiation oncologists responded to the survey for a response rate of 49%. Fifty-six percent of respondents reported an increase in locally advanced cervical cancer with no similar increase for endometrial, vulvar, or vaginal patients. Most respondents (66%) reported a pause in surgical management, with a duration of 1 to 3 months being most common (61%). There was a reported increased use of shorter brachytherapy regimens during the pandemic. Most providers (61%) reported caring for at least 1 patient with a positive COVID-19 test. A pause or delay in treatment due to COVID-19 positivity was reported by 45% of respondents, with 55% reporting that patients chose to delay their own care because of COVID-19-related concerns. Total treatment times >8 weeks for patients with cervical cancer were observed by 33% of respondents, but occurred in >25% of patients.

    Conclusions

    Data from this prospectively collected anonymous survey of practice patterns among radiation oncologists reveal that the COVID-19 pandemic resulted in delays initiating care, truncated brachytherapy treatment courses, and a reported increase in locally advanced cervical cancer cases at presentation. These data can be used as a means of self-assessment to ensure appropriate decision making for gynecologic patients during the endemic phase of COVID-19.
  • ItemOpen Access
    A novel multi-modality imaging phantom for validating interstitial needle guidance for high dose rate gynecological brachytherapy.
    (Journal of applied clinical medical physics, 2023-10) Eckroate, Brett; Ayala-Peacock, Diandra; Venkataraman, Rajesh; Campelo, Sabrina; Chino, Junzo; Stephens, Sarah Jo; Kim, Yongbok; Meltsner, Sheridan; Raffi, Julie; Craciunescu, Oana

    Purpose

    To design, manufacture, and validate a female pelvic phantom for multi-modality imaging (CT, MRI, US) to benchmark a commercial needle tracking system with application in HDR gynecological (GYN) interstitial procedures.

    Materials and methods

    A GYN needle-tracking phantom was designed using CAD software to model an average uterus from a previous patient study, a vaginal canal from speculum dimensions, and a rectum to accommodate a transrectal ultrasound (TRUS) probe. A target volume (CTVHR ) was designed as an extension from the cervix-uterus complex. Negative space molds were created from modeled anatomy and 3D printed. Silicone was used to cast the anatomy molds. A 3D printed box was constructed to house the manufactured anatomy for structural integrity and to accommodate the insertion of a speculum, tandem, needles, and TRUS probe. The phantom was CT-imaged to identify potential imperfections that might impact US visualization. Free-hand TRUS was used to guide interstitial needles into the phantom. The commercial tracking system was used to generate a 3D US volume. After insertion, the phantom was imaged with CT and MR and the uterus and CTVHR dimensions were verified against the CAD model.

    Results/conclusions

    The manufactured phantom allows for accurate visualization with multiple imaging modalities and is conducive to applicator and needle insertion. The phantom dimensions from the CAD model were verified with those from each imaging modality. The phantom is low cost and can be reproducibly manufactured with the 3D printing and molding processes. Our initial experiments demonstrate the ability to integrate the phantom with a commercial tracking system for future needle tracking validation studies.
  • ItemOpen Access
    The visual terms of state violence in Israel/Palestine: An interview with Rebecca L. Stein
    (Philosophy of Photography, 2023-04-01) Stein, Rebecca L; Levin, Noa; Fisher, Andrew
    This interview with media anthropologist, Rebecca L. Stein, conducted by Noa Levin and Andrew Fisher in Spring 2023, takes her recent book Screenshots: State Violence on Camera in Israel and Palestine (2021) as its starting point in order to explore issues of state violence and the militarization of social media in Israel/Palestine. This book marks the culmination of a decade-long research project into the camera dreams introduced by digital imaging technologies and the fraught histories of their disillusionment. Stein discusses the way her research has critically conceptualized the recent history of hopes invested in the digital image in this geopolitical context, by the occupier as much as the occupied, and charts the failures and mistakes, obstructions and appropriations that characterize the conflicted visual cultures of Israel/Palestine.
  • ItemOpen Access
    Tools to implement measurement-based care (MBC) in the treatment of opioid use disorder (OUD): toward a consensus
    (Addiction Science & Clinical Practice) Rush, A John; Gore-Langton, Robert E; Bart, Gavin; Bradley, Katharine A; Campbell, Cynthia I; McKay, James; Oslin, David W; Saxon, Andrew J; Winhusen, T John; Wu, Li-Tzy; Moran, Landhing M; Tai, Betty
    Abstract Background The prevalence and associated overdose death rates from opioid use disorder (OUD) have dramatically increased in the last decade. Despite more available treatments than 20 years ago, treatment access and high discontinuation rates are challenges, as are personalized medication dosing and making timely treatment changes when treatments fail. In other fields such as depression, brief measures to address these tasks combined with an action plan—so-called measurement-based care (MBC)—have been associated with better outcomes. This workgroup aimed to determine whether brief measures can be identified for using MBC for optimizing dosing or informing treatment decisions in OUD. Methods The National Institute on Drug Abuse Center for the Clinical Trials Network (NIDA CCTN) in 2022 convened a small workgroup to develop consensus about clinically usable measures to improve the quality of treatment delivery with MBC methods for OUD. Two clinical tasks were addressed: (1) to identify the optimal dose of medications for OUD for each patient and (2) to estimate the effectiveness of a treatment for a particular patient once implemented, in a more granular fashion than the binary categories of early or sustained remission or no remission found in The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Discussion Five parameters were recommended to personalize medication dose adjustment: withdrawal symptoms, opioid use, magnitude (severity and duration) of the subjective effects when opioids are used, craving, and side effects. A brief rating of each OUD-specific parameter to adjust dosing and a global assessment or verbal question for side-effects was viewed as sufficient. Whether these ratings produce better outcomes (e.g., treatment engagement and retention) in practice deserves study. There was consensus that core signs and symptoms of OUD based on some of the 5 DSM-5 domains (e.g., craving, withdrawal) should be the basis for assessing treatment outcome. No existing brief measure was found to meet all the consensus recommendations. Next steps would be to select, adapt or develop de novo items/brief scales to inform clinical decision-making about dose and treatment effectiveness. Psychometric testing, assessment of acceptability and whether the use of such scales produces better symptom control, quality of life (QoL), daily function or better prognosis as compared to treatment as usual deserves investigation.
  • ItemOpen Access
    Diabetes distress in Veterans with type 2 diabetes mellitus: Qualitative descriptive study.
    (Journal of health psychology, 2024-02) Lewinski, Allison A; Shapiro, Abigail; Crowley, Matthew J; Whitfield, Chelsea; Jones, Joanne Roman; Jeffreys, Amy S; Coffman, Cynthia J; Howard, Teresa; McConnell, Eleanor; Tanabe, Paula; Barcinas, Susan; Bosworth, Hayden B
    Diabetes distress (DD) is a negative psychosocial response to living with type 2 diabetes mellitus (T2DM). We sought insight into Veterans' experiences with DD in the context of T2DM self-management. The four domains in the Diabetes Distress Scale (i.e. regimen, emotional, interpersonal, healthcare provider) informed the interview guide and analysis (structural coding using thematic analysis). The mean age of the cohort (n = 36) was 59.1 years (SD 10.4); 8.3% of patients were female and 63.9% were Black or Mixed Race; mean A1C was 8.8% (SD 2.0); and mean DDS score was 2.4 (SD 1.1), indicating moderate distress. Veterans described DD and challenges to T2DM self-management across the four domains in the Diabetes Distress Scale. We found that (1) Veterans' challenges with their T2DM self-management routines influenced DD and (2) Veterans experienced DD across a wide range of domains, indicating that clinical interventions should take a "whole-person" approach.Trial Registration: NCT04587336.

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