Unfractionated heparin monitoring by anti-factor Xa versus activated partial thromboplastin time strategies during venoarterial extracorporeal life support.

Introduction: No clear guidelines exist for unfractionated heparin (UFH) monitoring in adult patients on veno-arterial extracorporeal life support (VA-ECLS) for refractory cardiogenic shock. In this study, we sought to compare outcomes between anti-factor Xa (FXa) and activated partial thromboplastin time (aPTT) strategies for UFH monitoring during VA-ECLS.

Methods: This is a single-center, retrospective review of VA-ECLS patients who received UFH in the cardiothoracic intensive care unit between July 2019 and November 2023.

Network Pharmacology and Metabolomics Reveal Anti-Ferroptotic Effects of Curcumin in Acute Kidney Injury.

Introduction: Acute kidney injury (AKI) is linked to high rates of mortality and morbidity worldwide thereby posing a major public health problem. Evidences suggest that ferroptosis is the primary cause of AKI, while inhibition of monoamine oxidase A(MAOA) and 5-hydroxytryptamine were recognized as the defender of ferroptosis. Curcumin (Cur) is a natural polyphenol and the main bioactive compound of , which has been found nephroprotection in AKI.

Comparing and assessing physical activity and sedentary behaviour guidelines for different populations with and without chronic conditions and/or disabilities: a systematic review protocol.

Physical activity guidelines targeting different populations with and without chronic diseases or disabilities are required to meet the diverse functional and physiological needs experienced by different subgroups of people to achieve optimal health benefits. As the importance of physical activity guidelines in promoting optimal health and well-being becomes increasingly recognised, there is a critical need for their systematic evaluation to ensure they remain effective, applicable and aligned with evolving health needs and scientific insights. This study aims to systematically review, critically evaluate, and compare global physical activity and sedentary behaviour guidelines on frequency, intensity, time, and type of exercise for adults, pregnant and postpartum women, and people living with chronic conditions and/or disabilities.

Trends in Opioid Use Disorder in the Veterans Health Administration, 2005-2022.

Importance: Given the personal and social burdens of opioid use disorder (OUD), understanding time trends in OUD prevalence in large patient populations is key to planning prevention and treatment services.

Objective: To examine trends in the prevalence of OUD from 2005 to 2022 overall and by age, sex, and race and ethnicity.

Design, Setting, And Participants: This serial cross-sectional study included national Veterans Health Administration (VHA) electronic medical record data from the VHA Corporate Data Warehouse.

Reproducibility of proton density fat fraction assessment of thigh muscle in a multi-site, multi-vendor cohort study at 10 years after anterior cruciate ligament reconstruction.

Background: Dixon-based magnetic resonance imaging (MRI) intramuscular proton density fat fraction (PDFF) is a potentially useful imaging biomarker of muscle quality. However, multi-vendor, multi-site reproducibility of intramuscular PDFF quantification, required for large clinical studies, can be strongly dependent on acquisition and processing. The purpose of this study was (I) to develop a 6-point Dixon MRI-based acquisition and processing technique for reproducible multi-vendor, multi-site quantification of thigh intramuscular PDFF; and (II) to evaluate the ability of the technique to detect differences in thigh muscle status between operated .

Increasing financial incentives can lower the cost of trial recruitment.

Monetary incentives are commonly used to help recruit trial participants. Some studies have found greater recruitment with larger incentives, while others have found smaller incentives more cost-effective in terms of cost per participant. As part of an implementation study, we compared the impact of four approaches to recruitment, three of which involved phone recruitment with varying financial incentives.

The social experience of uncertainty: a qualitative analysis of emergency department care for suspected pneumonia for the design of decision support.

Background: This study sought to understand the process of clinical decision-making for suspected pneumonia by emergency departments (ED) providers in Veterans Affairs (VA) Medical Centers. The long-term goal of this work is to create clinical decision support tools to reduce unwarranted variation in diagnosis and treatment of suspected pneumonia.

Methods: Semi-structured qualitative interviews were conducted with 16 ED clinicians from 9 VA facilities demonstrating variation in antibiotic and hospitalization decisions.

Childcare as a social determinant of access to healthcare: a scoping review.

Introduction: As health systems strive to screen for and address social determinants of health (SDOH), the role of access to childcare and barriers to healthcare posed by childcare needs remains underexplored. A gap exists in synthesizing existing evidence on the role of access to childcare as a SDOH.

Methods: This scoping review aimed to examine and analyze existing literature on the role of childcare needs as a social determinant of access to healthcare.

Vitamin D and Pancreatic Ductal Adenocarcinoma-A Review of a Complicated Relationship.

Introduction: From the observation of a negative relationship between UV-B exposure and cancer rates, we hypothesized that vitamin D (VD) may play a protective role in oncogenesis. Moreover, repurposing a well-known and relatively safe drug for conditions with dismal prospects, such as pancreatic ductal adenocarcinoma (PDAC), is a tempting idea. Thus, we aimed to summarize the current knowledge regarding the role of VD in the prevention and treatment of PDAC.

Mobile App-Facilitated Collaborative Palliative Care Intervention for Critically Ill Older Adults: A Randomized Clinical Trial.

Importance: Few person-centered, scalable models of collaborative intensive care unit (ICU) clinician-palliative care specialist care exist.

Objective: To evaluate the effect of a collaborative palliative care intervention compared to usual care among family members of patients in the ICU.

Design, Setting, And Participants: This parallel-group randomized clinical trial with patient-level randomization was conducted between April 2021 and September 2023.

Experience of Older Adults and Their Family Members in the Kidney Transplant Evaluation.

Importance: Transplant can be a valuable treatment option for older adults with kidney failure, and recent initiatives encourage more frequent referral to transplant centers. However, the evaluation process can be challenging, and most older adults do not ultimately receive a kidney.

Objective: To elucidate the perspectives and experiences of older adults with advanced kidney disease and their family members regarding the kidney transplant evaluation process.

Service Utilization and Consumer-Reported Unmet Needs in Medicaid Home- and Community-Based Services for Older Adults.

Home- and community-based services (HCBS) are increasingly favored over nursing home care by older consumers and by policymakers. Consumer-reported unmet service needs in HCBS are important service quality and person-centeredness indicators. Yet, we know little about consumer-reported unmet needs among HCBS users.

Understanding and Addressing Mental Health Disparities and Stigma in Serious Illness and Palliative Care.

Patients receiving palliative care experience stigma associated with their illness, personal identity, and healthcare utilization. These stigmas can occur at any stage of the disease process. Varying stigmas combine to cause palliative care patients to feel misunderstood, contribute to treatment barriers, and further negative stereotypes held by clinicians.

Confined phase behavior of subcritical carbon dioxide in nanoporous media: the effects of pore size and temperature.

This study investigates the effect of confinement on the phase behavior of carbon dioxide (CO) and its implications for storage in nanometer-scale pores. A patented gravimetric apparatus was employed to experimentally measure the adsorption and desorption isotherms at varying pore sizes and temperatures. The isotherms were generated at temperatures below the critical point of CO (from -23.

Ongoing evolution of SARS-CoV-2 drives escape from mRNA vaccine-induced humoral immunity.

With the onset of the COVID-19 pandemic 4 years ago, viral sequencing continues to document numerous individual mutations in the viral spike protein across many variants. To determine the ability of vaccine-mediated humoral immunity to combat continued SARS-CoV-2 evolution, we construct a comprehensive panel of pseudoviruses harboring each individual mutation spanning 4 years of the pandemic to understand the fitness cost and resistance benefits of each. These efforts identify numerous mutations that escape from vaccine-induced humoral immunity.

Cohort Profile: Baseline Characteristics of Veterans from Improving Veteran Access to Integrated Management of Back Pain (AIM-Back) - an Embedded Pragmatic, Cluster Randomized Trial in the United States.

Purpose: AIM-Back is an embedded pragmatic clinical trial (ePCT) with cluster randomization designed to increase access and compare the effectiveness of two different non-pharmacological care pathways for low back pain (LBP) delivered within the Veteran Administration Health Care System (VAHCS). This manuscript describes baseline characteristics of AIM-Back participants as well as the representativeness of those referred to the AIM-Back program by sex, age, race, and ethnicity, relative to Veterans with low back pain at participating clinics.

Participants: To be eligible for AIM-Back, Veterans were referred to the randomized pathway at their clinic by trained primary care providers (Referral cohort).

Characterizing Emergency Department Disposition Conversations for Persons Living With Dementia: Protocol for an Ethnographic Study.

Background: Almost 40% of persons living with dementia make an emergency department (ED) visit each year. One of the most impactful and costly elements of their ED care is the decision to discharge or admit them to the hospital-the "disposition" decision. When more than one reasonable option exists regarding a health care decision, such as the decision to admit or not, it often requires a complex conversation between patients, care partners, and ED providers, ideally involving shared decision-making.

Medicare Enrollment and Spending Among Patients Initiating Dialysis After the Affordable Care Act.

Importance: Medicare finances health care for most US patients with end-stage kidney disease (ESKD), regardless of age. Medicare enrollment may have slowed for patients with incident ESKD who gained access to new private insurance options with the 2014 passage of the Affordable Care Act (ACA) and introduction of the ACA Marketplace.

Objective: To describe trends in public and private insurance coverage and dialysis spending among patients with incident ESKD from 2012 to 2017.

Extraction of chitin and chitosan from Hermetia illucens breeding waste: A greener approach for industrial application.

Sustainably exploiting the waste of the black soldier fly (BSF) to produce chitin and chitosan remains a challenge. This work valorizes the pupal cases of BSF for chitin and chitosan extraction. Four chemical extraction processes have been employed.

Implementing INTERACT in Veterans Health Administration Community Living Centers: A pragmatic randomized trial.

Background: Hospital transfers from VA Community Living Centers (CLCs) are common. The objective of this study was to evaluate the effect of introducing the Intervention to Reduce Acute Care Transfers (INTERACT) program into VA CLCs.

Methods: Cluster randomized trial involving 16 pair-matched VA CLCs.