When Going Digital Becomes a Necessity: Ensuring Older Adults' Needs for Information, Services, and Social Inclusion During COVID-19.

Older adults are in triple jeopardy during COVID-19: compared with younger people, older adults are (1) more likely to develop serious conditions and experience higher mortality; (2) less likely to obtain high quality information or services online; and (3) more likely to experience social isolation and loneliness. Hybrid solutions, coupling online and offline strategies, are invaluable in ensuring the inclusion of vulnerable populations. Most of these solutions require no new inventions.

The Collision of COVID-19 and the U.S. Health System.

In this article, leaders from the American College of Physicians (ACP) discuss key recommendations from ACP's vision for U.S. health care that can advise how we can act now during the COVID-19 pandemic and in the future in service to patients, our peers, and the profession.

Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care.

This paper is part of the American College of Physicians' policy framework to achieve a vision for a better health care system, where everyone has coverage for and access to the care they need, at a cost they and the country can afford. Currently, the United States is the only wealthy industrialized country that has not achieved universal health coverage. The nation's existing health care system is inefficient, unaffordable, unsustainable, and inaccessible to many.

Envisioning a Better U.S. Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health.

The American College of Physicians (ACP) has long advocated for universal access to high-quality health care in the United States. Yet, it is essential that the U.S.

Restoration of resident sleep and wellness with block scheduling.

Context: Block scheduling during residency is an innovative model in which in-patient and ambulatory rotations are separated. We hypothesised that this format may have a positive impact on resident sleep and wellness in comparison with a traditional format.

Methods: We performed a single-centre, cross-sectional, observational study of residents rotating in the medical intensive care unit (MICU).

Daily Quantity of Infant Leg Movement: Wearable Sensor Algorithm and Relationship to Walking Onset.

Background: Normative values are lacking for daily quantity of infant leg movements. This is critical for understanding the relationship between the quantity of leg movements and onset of independent walking, and will begin to inform early therapy intervention for infants at risk for developmental delay.

Methods: We used wearable inertial movement sensors to record full-day leg movement activity from 12 infants with typical development, ages 1-12 months.

Neonatal estrogen exposure results in biphasic age-dependent effects on the skeletal development of male mice.

Peak bone mass, one of the most important predictors for fracture risk later in life, is attained during puberty and adolescence and influenced by neonatal and pubertal sex-specific gonadal hormones and GH-IGF-I secretion patterns. This study examined the effects of brief neonatal estrogen (NE) exposure on growth and skeletal development in C57BL/6J mice. A single injection of 100-μg estradiol or vehicle was administered on the first day of life.

Effects of amplitude cueing on postural responses and preparatory cortical activity of people with Parkinson disease.

Background And Purpose: Persons with Parkinson disease (PD) are unable to modify their postural responses, and show an associated increase in cortical preparatory activity for anticipated postural perturbations. In this study we asked whether participants with PD could modify their postural responses and cortical preparatory activity when cued to focus on increasing movement amplitude before a series of predictable postural perturbations.

Methods: Twelve participants with PD performed postural responses to 30 identical backward surface translations.

Patients With Hepatocellular Carcinoma Near the End of Life: A Longitudinal Qualitative Study of Their Illness Experiences.

Background: In the United States, the incidence of hepatocellular carcinoma (HCC) is rising. For those diagnosed with terminal HCC, there is no curative treatment and duration of survival is typically 1 to 2 years. Research on illness and treatment experiences toward the end of life for patients with terminal HCC is limited.

Training the next generation's nephrology workforce.

The subspecialty of nephrology faces several critical challenges, including declining interest among medical students and internal medicine residents and worrisome declines in the number of applicants for nephrology fellowships. There is an urgent need to more clearly define the subspecialty and its scope of practice, reinvigorate meaningful research training and activities among trainees, and ensure that fellows who complete training and enter the practice of nephrology are experts in the broad scope of nephrology. This need requires a critical look at fellowship training programs and training requirements.

Distal convoluted tubule.

The distal convoluted tubule is the nephron segment that lies immediately downstream of the macula densa. Although short in length, the distal convoluted tubule plays a critical role in sodium, potassium, and divalent cation homeostasis. Recent genetic and physiologic studies have greatly expanded our understanding of how the distal convoluted tubule regulates these processes at the molecular level.

Screening for lung cancer with low-dose computed tomography: a systematic review to update the US Preventive services task force recommendation.

Background: Lung cancer is the leading cause of cancer-related death in the United States. Because early-stage lung cancer is associated with lower mortality than late-stage disease, early detection and treatment may be beneficial.

Purpose: To update the 2004 review of screening for lung cancer for the U.

Effectiveness and harms of recombinant human bone morphogenetic protein-2 in spine fusion: a systematic review and meta-analysis.

Background: Recombinant human bone morphogenetic protein-2 (rhBMP-2) is used as a bone graft substitute in spinal fusion, which unites (fuses) bones in the spine. The accuracy and completeness of journal publications of industry-sponsored trials on the effectiveness and harms of rhBMP-2 has been called into question.

Purpose: To independently assess the effectiveness and harms of rhBMP-2 in spinal fusion and reporting bias in industry-sponsored journal publications.

Folate intake and prostate cancer risk: a case-control study.

Folate deficiency has been implicated in the carcinogenesis of several tumor types. The role of folate in prostate cancer remains indeterminate. We investigated folate as a risk factor for prostate cancer among 140 biopsy-confirmed prostate cancer patients, 230 age-matched clinic controls, and 250 negative prostate biopsy controls.

The role of A-kinase anchoring proteins (AKaps) in regulating sperm function.

Cyclic AMP (cAMP)-dependent protein kinase (PKA) is a signalling molecule involved in the regulation of many physiological functions including those of cilia and flagella. PKA localizes to specific cellular structures and organelles by binding to AKAP (A-kinase anchoring protein) molecules via interaction with the regulatory subunits (RI and RII) of PKA. AKAPs are capable of forming multi-protein complexes to coordinate the action of several signalling molecules all at a single location.

FLT3 K663Q is a novel AML-associated oncogenic kinase: Determination of biochemical properties and sensitivity to Sunitinib (SU11248).

Somatic mutations of FLT3 resulting in constitutive kinase activation are the most common acquired genomic abnormality found in acute myeloid leukemia (AML). The majority of these mutations are internal tandem duplications (ITD) of the juxtamembrane region (JM). In addition, a minority of cases of AML are associated with mutation of the FLT3 activation loop (AL), typically involving codons D835 and/or I836.

Celecoxib is efficacious and well tolerated in treating signs and symptoms of ankylosing spondylitis.

Objective: To evaluate the efficacy and safety of celecoxib in patients with ankylosing spondylitis (AS).

Methods: This was a 12-week randomized, double-blind, placebo-controlled study with 4 treatment arms: celecoxib 200 mg qd, celecoxib 400 mg qd, naproxen 500 mg bid, and placebo. Patients (age 18-75 yrs) requiring daily treatment with nonselective nonsteroidal antiinflammatory drugs, and with a pain intensity on visual analog scale (VAS) > or = 50 mm worsening by 30% compared with a preinclusion visit (14 days prior) were studied.

High dose pulse calcitriol, docetaxel and estramustine for androgen independent prostate cancer: a phase I/II study.

Purpose: We determined the safety and preliminary efficacy of the combination of high dose pulse calcitriol (1,25-dihydroxycholecalciferol) with a standard regimen of docetaxel plus estramustine in patients with metastatic androgen independent prostate cancer.

Materials And Methods: Patients were treated with 60 microg calcitriol orally on day 1, 280 mg estramustine orally 3 times daily on days 1 to 5 and 60 mg/m docetaxel on day 2 (70 mg/m after cycle 1) every 21 days for up to 12 cycles. Patients also received 325 mg aspirin and 1 or 2 mg warfarin orally daily.

Quality of dying in the ICU: ratings by family members.

Study Objectives: To explore the quality of the dying experience and associations to higher quality ratings for people who died in an ICU.

Design: Retrospective study using medical record review and surveys of family members with the Quality of Dying and Death (QODD) instrument.

Setting: Four ICUs affiliated with a university and a Veterans Affairs Medical Center.

Challenges in systematic reviews that assess treatment harms.

An evidence synthesis of a medical intervention should assess the balance of benefits and harms. Investigators performing systematic reviews of harms face challenges in finding data, rating the quality of harms reporting, and synthesizing and displaying data from different sources. Systematic reviews of harms often rely primarily on published clinical trials.

Steroid-responsive idiopathic glomerular capillary endotheliosis: case report and literature review.

Glomerular capillary endotheliosis is a lesion of endothelial cell injury. Morphological characteristics are endothelial swelling with glomerular hypertrophy and a reduction in capillary lumen size. This lesion commonly is found in patients with thrombotic microangiopathy, but similar histopathologic characteristics have been reported in patients with other diseases.