Delgado Community College

BackgroundMulticomponent strategies can reduce benzodiazepine (BZD) use. BenzoStopJuntos (Spanish for “Stop Benzos Together”), a multidisciplinary deprescribing programme of the Andalusian Health Service, supports patients to taper/stop BZD through education, behavioral support, and non-pharmacological alternatives. We evaluated whether early changes (6 months) in risk perception and attitudes—and secondarily, quality of life—were associated with long-term discontinuation of BZD.MethodsIn a quasi-experimental pre–post study in two primary care centres (Seville, Spain; n = 243), the intervention included patient education, tapering support, and alternatives for anxiety/insomnia delivered by a multidisciplinary team. Primary outcomes were (a) short-term (6-month) changes in risk perception and attitudes and (b) long-term BZD discontinuation over 5.5 years; the secondary outcome was quality of life (WONCA/COOP), monitored to detect potential harms. Multivariable logistic regression examined whether 6-month changes in beliefs/attitudes predicted subsequent discontinuation, adjusting for sociodemographic and clinical factors.ResultsBZD discontinuation increased from 31.3 % at 6 months to 40.7 % at 5.5 years. Participants who considered BZD safe long-term were more likely to continue use (OR = 2.0; 95 % CI: 1.6–2.6). Fears of worsened anxiety/sleep strongly predicted persistence (OR = 4.7; 95 % CI: 3.6–6.1). Prior intermittent vs continuous use favored discontinuation (OR = 4.9; 95 % CI: 3.7–6.5). Quality of life improved in emotional, social, and physical domains, with no deterioration observed during follow-up.ConclusionsTailored education and behavioral strategies changed risk perceptions and attitudes, which in turn facilitated sustained BZD discontinuation without adverse effects on quality of life. Addressing patient beliefs and encouraging intermittent use patterns may enhance deprescribing success.Trial registrationClinicalTrials.govNCT06209827

BackgroundOral immunotherapy (OIT) with peanut (Arachis hypogaea) allergen powder-dnfp (PTAH; Aimmune Therapeutics) is an FDA-approved treatment to desensitize peanut allergic participants.ObjectiveHere we assessed shifts in IgE and IgG4 binding to peanut allergens and their epitopes recognized by United States (US) peanut allergic participants (n = 20) enrolled in phase 3 PTAH OIT clinical trials.MethodsPre- and post- trial participant sera were collected approximately 12 months apart and tested for IgE binding to intact peanut proteins via ImmunoCAP ISAC immunoassays. IgE and IgG4 linear epitopes were identified based on binding to synthetic overlapping 15-mer linear peptides of 10 peanut allergens (Ara h 1-11) synthesized on microarray slides.ResultsStatistically significant decreases in IgE binding were identified for intact Ara h 2, 3, and 6, and known and newly identified IgE epitopes were shown to exhibit shifts towards IgG4 binding post-OIT, with most linear peptides having increased IgG4 binding after treatment with PTAH. While PTAH does not seem to alter the actual peptide binding patterns significantly after one year of treatment, the IgE and IgG4 binding ratios and intensity are altered.ConclusionAt a population level, the linear IgE and IgG4 epitopes of 10 peanut allergens overlap and that increase in IgG4 with OIT results in displacement of IgE binding to both conformational and linear epitopes. Furthermore, it appears as though the increase in IgG4 is more important to achieve desensitization at the 12-month timepoint than the decrease in IgE. This type of knowledge can be useful in the identification of IgE and IgG4-binding allergen and peptide biomarkers that may indicate desensitization or sustained unresponsiveness of allergic individuals to peanut.

Chronic sleep deficiency (CSD) poses a threat to physical health, mental well-being, and social functioning. The concept of behaviorally induced CSD has not changed much since it was first introduced four decades ago. Behaviorally induced CSD is currently referred to as insufficient sleep syndrome (ISS). In the latest edition of the International Classification of Sleep Disorders (ICSD-3, 2014), ISS is considered a disorder of central hypersomnolence with diagnostic codes ICD-9-CM 307.44 and ICD-10-CM F51.12. In this review, we will describe the biological importance of sleep, the ramifications of CSD on the individual and society, the nosological status and diagnostic features of ISS, and the apparent lack of attention to ISS in contemporary medical practice and public health programs. The last three decades have seen a global rise in voluntary sleep curtailment such that ISS may already be the leading cause of CSD, not only in adults but also in school-aged children and adolescents. Acknowledging ISS as a public health priority is a necessary first step in our response to the global threat of CSD and CSD-related health consequences. It is only by confronting ISS directly that we can hope to develop and implement effective educational and advocacy programs, along with more responsible public health policies and regulations.

Animals rely on their ability to perform certain tasks sufficiently well to survive, secure mates and reproduce. Performance traits depend on morphology, and so morphological traits should predict performance, yet this relationship is often confounded by multiple competing performance demands. Males and females experience different selection pressures on performance, and the consequent sexual conflict over performance expression can either constrain performance evolution or drive sexual dimorphism in both size and shape. Furthermore, change in a single morphological trait may benefit some performance traits at the expense of others, resulting in functional trade-offs. Identifying general or sex-specific relationships between morphology and performance at the organismal level thus requires a multivariate approach, as individuals are products of both an integrated phenotype and the ecological environment in which they have developed and evolved. We estimated the multivariate morphology→performance gradient in wild-caught, green anoles (Anolis carolinensis) by measuring external morphology and forelimb and hindlimb musculature, and mapping these morphological traits to seven measured performance traits that cover the broad range of ecological challenges faced by these animals (sprint speed, endurance, exertion distance, climbing power, jump power, cling force and bite force). We demonstrate that males and females differ in their multivariate mapping of traits on performance, indicating that sex-specific ecological demands likely shape these relationships, but do not differ in performance integration.

Background:There are limited data on the performance or pitching metrics of Major League Baseball (MLB) pitchers who returned to play after ulnar collateral ligament reconstruction (UCLR).Purpose:To describe MLB pitcher performance after return from primary UCLR, compare the velocity and pitch characteristics against the preoperative season, and determine if performance analytics can predict successful return to pitching after UCLR.Study Design:Case-control study; Level of evidence, 3.Methods:This study included 63 pitchers who underwent primary UCLR between 2015 and 2019. Publicly available advanced analytics and pitch metrics from the first 2 postoperative seasons were compared with the preoperative (index) season as well as with an uninjured control group.Results:Overall, 57% of the pitchers successfully returned to the MLB level. Although they threw significantly fewer pitches (P = .012) and innings (P = .022) in postoperative year 1 as compared with the index season, there were no significant differences in pitch velocity, release extension, perceived velocity, or performance as measured by advanced analytics. Also, as compared with the index season, returners demonstrated increased postoperative spin rates on curveballs (P = .001) and sliders (P = .010), and curveball horizontal movement was significantly increased (P = .007); however, horizontal movement was significantly decreased for 4-seam fastballs (P = .026), changeups (P = .005), and sinkers (P = .019). The vertical movement on 4-seam fastballs was greater (P < .001) in postoperative year 1, and the vertical movement on curveballs (P = .031) and sinkers (P = .010) was greater in postoperative year 2 when compared with the index season. Pitchers who failed to return to the MLB level had a lower preoperative strikeout percentage (P = .047), fewer strikeouts per 9 innings pitched (P = .046), fewer wins above replacement ([WAR]; P = .026), and lower player value (P = .030) than the pitchers who returned.Conclusion:Pitchers returning to the MLB level after UCLR demonstrated changes in pitch movement profiles and spin rates postoperatively, but there were no differences in velocity or many advanced analytics upon return. Pitchers with lower strikeout metrics, fewer WAR, and less player value before surgery may have an elevated risk of failing to return to the MLB level.

Objectives Teamwork training and patient safety efforts often focus on culture change.1 Introduction to these topics early in training may contribute to changing an institution’s culture. Of the few examples of undergraduate medical education patient safety courses appear in the literature, curricula involving pre-clinical students were rare2-3 and utilized primarily large lecture and small-group discussion formats.3 In contrast to patient safety for practicing providers, a major challenge in the pre-clinical years is to create the relevance needed to go beyond knowledge and attitudinal changes and achieve higher levels of Kirkpatrick’s framework such as behavioral changes. To achieve this, we describe a comprehensive year-long patient safety course that incorporates adult-learning principles, including “flipped classroom” and team-based learning, as well as technology-enhanced simulations.4 Description The Tulane Interprofessional Patient Safety course (TIPS) uses a combination of teaching methods to cultivate the appropriate degree of relevance to instruct pre-clinical students in patient safety. Students (n=200) work in peer teams composed of 3 medical and 3 nursing students. Pre-session work involves online modules from the Institute for Healthcare Improvement and “flipped classroom” background materials developed specially for the course. As described in the attached table, the curriculum uses a combination of small-group discussion, team-based learning, task-oriented simulations, and mannequin simulations to deliver the patient safety content. Measurements include knowledge, attitudinal, and perception assessments (Team Performance Scale, Value of Teams, and the Readiness for Interprofessional Learning Scale) as well as 360-degree peer evaluations, direct observation checklists using the Team Performance Observation Tool, and narrative descriptions of behaviors in conjunction with facilitated debriefing. Portions of the course (degree of team training) involved randomization. Students showed a significant increase in the attitudinal scores, perception of the value of teams as well as observed team performance during simulations. Conclusion Assess the degree to which the design objectives were achieved, accurate appraisal of limitations, discussion of next steps and future applications. Indicate how outcomes are relevant to potential benefits for healthcare simulation. Describe the contribution of the project to current knowledge, methods or technologies. This curriculum was intended to move patient safety in the pre-clinical years out of theoretical discussions and into hands-on activities more directly related to healthcare delivery. We were able to demonstrate some improvement in perceptions of teamwork and increased awareness of patient safety and clear observations of good teamwork and patient safety behaviors. However, it is not to what extent these improvements are the result of our interventions as control groups were unavailable in the majority of encounters. The extent to which students utilized teamwork training or patient safety material that were not provided by the curriculum (i.e. contamination) is another key limitation. By using various teaching methodologies and designing a curriculum that focuses on simulation scenarios, it is possible for pre-clinical students to demonstrate patient safety behaviors, in addition to increases in knowledge and attitudes.

Dadson, Emma. Lanham, MD: Scarecrow Press, Inc., 2012. 240p. ISBN 978-0-81088-756-5. $80.00. The intent of Emergency Planning and Response for Libraries, Archives and Museums (“Emergency Planning”)...