Implementation strategies for decentralized management of multidrug-resistant tuberculosis: insights from community health systems in Zambia.

Background: Decentralized management approaches for multi-drug-resistant tuberculosis (MDR TB) have shown improved treatment outcomes in patients. However, challenges remain in the delivery of decentralized MDR TB services. Further, implementation strategies for effectively delivering the services in community health systems (CHSs) in low-resource settings have not been fully described, as most strategies are known and effective in high-income settings.

The Child Welfare System's Response to the National Mental Health Crisis.

The nation's child welfare system serves the most vulnerable youth and families and so has been impacted dramatically by the coronavirus disease 2019 pandemic with decreases of abuse reporting, delayed toward permanency, and increased disproportionality. Youth in foster care have increased likelihood of boarding in hospital emergency rooms or nontraditional placements. These issues are magnified in exceptional vulnerable populations such as American Indian and Alaska Native children.

Perceptions of extended-release buprenorphine among people who received medication for opioid use disorder in jail: a qualitative study.

Background: Incarceration provides an opportunity for health interventions, including opioid use disorder (OUD) treatment and prevention of opioid-related overdoses post-release. All FDA-approved forms of medication for OUD (MOUD) treatment were mandated in several Massachusetts jails in 2019, with some jails offering extended-release buprenorphine (XR-Bup). Little is known about patient perspectives on and experiences with XR-Bup in carceral settings.

Management of Cholesteatoma: Surgical Options for Disease Limited to Middle Ear/Mastoid.

Surgery remains the mainstay of cholesteatoma management. Through advancement in technique and technology, the available surgical approaches have expanded to include not only the traditional procedures, but also endoscopic procedures, canal wall reconstruction procedures, mastoid obliteration, and retrograde mastoidotomy. Selection of management technique will depend on disease characteristics, patient factors, and surgeon preference.

Nongovernmental Organizations in Global Neurosurgery: Foundation for International Education in Neurological Surgery and Solidarity Bridge.

Health care disparities between high-income countries (HICs) and low- and middle-income countries (LMICs) are well established. The focus of the surgical aspect of health was identified in the early twenty-first century, and efforts to provide safe surgical intervention require the shift of resources from HICs to LMICs with specialized surgeons, anesthesiologists, and equipment. This intervention may make a difference on the short run; however, to achieve a long-term self-sustaining surgical service in the region of need, education and training of local physicians is key.

Blocking the PD-1 signal transduction by occupying the phosphorylated ITSM recognition site of SHP-2.

Targeting the PD-1/PD-L1 axis with small-molecular inhibitors is a promising approach for immunotherapy. Here, we identify a natural pentacyclic triterpenoid, Pygenic Acid A (PA), as a PD-1 signaling inhibitor. PA exerts anti-tumor activity in hPD-1 knock-in C57BL/6 mice and enhances effector functions of T cells to promote immune responses by disrupting the PD-1 signaling transduction.

The association of exhaled carbon monoxide with atrial fibrillation and left atrial size in the Framingham Heart Study.

Background: Exhaled carbon monoxide (eCO) is associated with subclinical and overt cardiovascular disease and stroke. The association between eCO with left atrial size, prevalent, or incident atrial fibrillation (AF) are uncertain.

Methods: eCO was measured using an Ecolyzer instrument among Framingham Heart Study Offspring and Omni participants who attended an examination from 1994 to 1998.

Androgens contribute to sex bias of autoimmunity in mice by T cell-intrinsic regulation of Ptpn22 phosphatase expression.

Autoimmune diseases such as systemic lupus erythematosus (SLE) display a strong female bias. Although sex hormones have been associated with protecting males from autoimmunity, the molecular mechanisms are incompletely understood. Here we report that androgen receptor (AR) expressed in T cells regulates genes involved in T cell activation directly, or indirectly via controlling other transcription factors.

Implementing virtual desktops for clinical research at an academic health center: a case report.

Objectives: To address the challenges of sharing clinical research data through the implementation of cloud-based virtual desktops, enhancing collaboration among researchers while maintaining data security.

Materials And Methods: This case study details the deployment of virtual desktops at UMass Chan Medical School (UMass Chan). The process involved forming a Research Informatics Steering Executive workgroup, identifying key requirements, implementing Amazon WorkSpaces, and establishing configurable data management for research support.

Sexual and Reproductive Healthcare Needs of Refugee Women Exposed to Gender-Based Violence: The Case for Trauma-Informed Care in Resettlement Contexts.

This paper assesses literature regarding the sexual and reproductive healthcare (SRH) needs of resettled refugee women who experienced gender-based violence (GBV) and trauma-informed care (TIC) principles utilized among SRH service providers. A systematic search identified relevant studies published between 2000 and 2021; no articles found reflected both SRH and TIC principles among refugee women. The search was therefore separated into two aims: to review the literature about SRH needs for refugee women in resettlement countries who experienced GBV (Aim 1) and to examine the use of TIC principles in SRH care among women who experienced GBV (Aim 2).

A minimally invasive endovascular approach to the cerebellopontine angle cistern enables broad CNS biodistribution of scAAV9-CB-GFP.

Neurological disorders pose a challenge for targeted therapy due to restricted access of therapeutic agents to the central nervous system (CNS). Current methods are limited by procedure-related risks, invasiveness, and insufficient CNS biodistribution. A novel percutaneous transvenous technology, currently in clinical trials for communicating hydrocephalus, offers a minimally invasive approach by providing endovascular access to the cerebrospinal fluid-filled cerebellopontine angle (CPA) cistern.

Thyroid hormone remodels cortex to coordinate body-wide metabolism and exploration.

Animals adapt to environmental conditions by modifying the function of their internal organs, including the brain. To be adaptive, alterations in behavior must be coordinated with the functional state of organs throughout the body. Here, we find that thyroid hormone-a regulator of metabolism in many peripheral organs-directly activates cell-type-specific transcriptional programs in the frontal cortex of adult male mice.

FRA1 controls acinar cell plasticity during murine Kras-induced pancreatic acinar to ductal metaplasia.

Acinar cells have been proposed as a cell-of-origin for pancreatic ductal adenocarcinoma (PDAC) after undergoing acinar-to-ductal metaplasia (ADM). ADM can be triggered by pancreatitis, causing acinar cells to de-differentiate to a ductal-like state. We identify FRA1 (gene name Fosl1) as the most active transcription factor during Kras acute pancreatitis-mediated injury, and we have elucidated a functional role of FRA1 by generating an acinar-specific Fosl1 knockout mouse expressing Kras.

Psychosocial Trauma History Negatively Impacts Liver Transplant Access in Women with Chronic Liver Disease.

Introduction: Few studies have evaluated the impact of psychological trauma (mental, emotional, or physical) on liver transplant (LT) candidacy and outcomes.

Methods: We performed a single center retrospective analysis of patients who completed routine LT evaluation between October 2017 and June 2021. We identified the prevalence of psychological trauma history in men and women LT candidates and evaluated the association between trauma history and LT access.

The Use of Smartphone-Based Highly Realistic MCI Training as an Adjunct to Traditional Training Methods.

Introduction: Training for mass casualty incident (MCI) response is critical to ensure that resource allocation and treatment priorities limit preventable mortality. Previous research has investigated the use of immersive virtual environments as an alternative to high fidelity MCI training, which is expensive and logistically challenging to implement. While these have demonstrated positive early results, they still require complex technology deployment, dedicated training facilities, and significant time from instructors and facilitators.

A self-complementary AAV proviral plasmid that reduces cross-packaging and ITR promoter activity in AAV vector preparations.

Adeno-associated viral vectors (AAVs) are a leading delivery system for gene therapy in animal models and humans. With several Food and Drug Administration-approved AAV gene therapies on the market, issues related to vector manufacturing have become increasingly important. In this study, we focused on potentially toxic DNA contaminants that can arise from AAV proviral plasmids, the raw materials required for manufacturing recombinant AAV in eukaryotic cells.

Implementing Screening, Brief Interventions, and Referral to Treatment at Pediatric Trauma Centers: A Step Wedge Cluster Randomized Trial.

Background: Pediatric trauma centers have had challenges meeting the American College of Surgeons criteria for screening and intervening for alcohol with adolescent trauma patients. The study objective was to conduct an implementation trial to evaluate the effectiveness of the Science to Service Laboratory (SSL) implementation strategy in improving alcohol and other drugs (AOD) screening, brief intervention, and referral to treatment (SBIRT) delivery at pediatric trauma centers.

Methods: Using a stepped wedge cross-over cluster randomized design, 10 US pediatric trauma centers received the SSL implementation strategy to deliver SBIRT with admitted adolescent (12-17 years old) trauma patients.

Polymer physics models reveal structural folding features of single-molecule gene chromatin conformations.

Here, we employ polymer physics models of chromatin to investigate the 3D folding of a 2Mb wide genomic region encompassing the human gene, a crucial DNA locus involved in key cellular functions. Through extensive Molecular Dynamics simulations, we reconstruct in-silico the ensemble of single-molecule 3D structures, which we benchmark against recent in-situ Hi-C 2.0 data.

Development and validation of a community risk score for sexual and reproductive health in the United States.

Equitable access to sexual and reproductive health (SRH) care is key to reducing inequities in SRH outcomes. Publicly funded family-planning services are an important source of SRH care for people with social risk factors that impede their access. This study aimed to create a new index (Local Social Inequity in SRH [LSI-SRH]) to measure community-level risk of adverse SRH outcomes based on social determinants of health (SDoH).