Precision Research Institute

For patients with atrial fibrillation, the use of oral anticoagulant therapy to prevent stroke is limited by the risk of bleeding. Left atrial appendage closure is considered for patients who are unsuitable candidates for long-term anticoagulation, but its role in patients who are eligible for anticoagulants has not been established. In this ongoing, prospective, international, randomized trial involving patients with atrial fibrillation who were suitable candidates for anticoagulation, we randomly assigned patients in a 1:1 ratio to receive either device-based left atrial appendage closure (device group) or non-vitamin K antagonist oral anticoagulant (NOAC) therapy (anticoagulation group). The primary efficacy end point - a composite of death from cardiovascular causes, stroke, or systemic embolism - was tested for noninferiority (noninferiority margin, 4.8 percentage points) after 3 years of follow-up. The primary safety end point, non-procedure-relatedbleeding, was tested for superiority. Of the 3000 patients who underwent randomization, 1499 were assigned to the device group and 1501 to the anticoagulation group. The mean (±SD) age of the patients was 71.7±7.5 years, 31.9% of the patients were women, and the mean CHA2DS2-VASc score was 3.5±1.3. At 3 years, a primary efficacy end-point event had occurred in 81 patients (Kaplan-Meier estimate, 5.7%) in the device group and in 65 patients (Kaplan-Meier estimate, 4.8%) in the anticoagulation group (difference, 0.9 percentage points; 95% confidence interval [CI], -0.8 to 2.6; P<0.001 for noninferiority). Non-procedure-related bleeding occurred in 154 patients (Kaplan-Meier estimate, 10.9%) in the device group and in 260 patients (Kaplan-Meier estimate, 19.0%) in the anticoagulation group (hazard ratio, 0.55; 95% CI, 0.45 to 0.67; P<0.001 for superiority). Among patients with atrial fibrillation who were candidates for anticoagulation, device-based left atrial appendage closure was noninferior to NOAC therapy with respect to a composite of death from cardiovascular causes, stroke, or systemic embolism and was superior to NOAC therapy for non-procedure-related bleeding at 3 years. (Funded by Boston Scientific; CHAMPION-AF ClinicalTrials.gov number, NCT04394546.).

The objective of this study is to use a machine learning approach to identify predictors of BMI percentile among Hispanic/Latino youth in the United States. Participants were Hispanic/Latino 8- to 16-year-olds from the cross-sectional Study of Latino Youth (SOL Youth; n = 1466). A supervised machine learning approach, LASSO regression, was used with BMI percentile as the outcome. A total of 102 predictor variables were examined spanning parent and child demographics; health behaviors; and psychological, sociocultural, and environmental measures. Mean age of participants was 12 years, 50% were female, and 44.2% were of Mexican heritage. A 36-variable LASSO model yielded the optimum mean squared error (R 2 = 0.42), but a 10-variable solution was selected for parsimony. Six associations were significant. Dieting 1-4 or ≥ 5 times/year (β = 8.69 [95% CI: 10.25 to 14.52] or 10.86 [95% CI: 13.14 to 18.33], respectively) and having a parent of Dominican heritage (β = 3.48 [95% CI: 4.05 to 9.90]) or with obesity (β = 2.96 [95% CI: 2.99 to 6.85]) were associated with a higher BMI percentile. Perception of being smaller than the "ideal" body size (β = -1.65 [95% CI: -6.84 to -1.35]) and use of the food/activity parenting practice Control (β = -1.17 [95% CI: -3.63 to -1.69]) were associated with a lower BMI percentile. Family-based approaches and focusing on dieting and body image satisfaction may be important for weight management in Hispanic/Latino youth.

Abstract Nurses experience significantly more shared suffering and loss than those in other disciplines. This shared suffering, if not mitigated, can lead to disproportionate levels of burnout, absenteeism, and intent to leave the profession. Contracts with off-site Employee Assistance Programs (EAP) have been widely adopted to mitigate these outcomes. Some examples of cost savings are decreased turnover, decreased reliance on contracted staff, and increased productivity. Despite these truths, EAPs are often underutilized by nurses. Also, nursing staff may be unaware of the resource's availability or how to access it.Among the on-site programs are peer supporter programs. Peer supporter programs involve specific training for care team members in supportive therapeutic interaction. The peer supporter can then offer help from a similar and shared perspective. However, the peer supporter model remains under-researched. In critical care areas, the mental health needs of nursing staff may exceed the ability of a peer supporter to intervene in a meaningful way.A professional therapist present on the care team in the intensive care unit has been associated with “normalizing” psychotherapy and was far preferred over seeking outside support. Methods We tested the model of a therapist on the care team to determine nurses’ utilization of the team therapist compared to other types of available support. Outcome measures included job satisfaction, burnout, resiliency, and self-efficacy. Results In this sample (n = 116), primarily female (78%), with a mean year of experience of 12 years (SD 8.1), the intervention was associated with improvement in the following domains: job satisfaction (p = 0.003, d = 0.860), burnout (p &amp;lt; 0.001, d = 0.793), and resiliency (p &amp;lt; 0.001, d = 0.622). Compared to outside help, time spent with the onsite team therapist statistically impacted nurses’ self-efficacy (p = 0.008, v = 0.258). Of the following variables: years of experience, shift (days vs nights), role (clinical vs non-clinical), gender, and ethnicity, none had a statistically significant relationship to burnout, resiliency, or job satisfaction. Conclusion In this investigation, adding a professional therapist to the care team to support nursing staff was associated with decreased self-reported burnout and improvement in self-reported resiliency and self-efficacy. Further research should be done to reproduce findings to support generalizability. Additionally, longitudinal analysis could demonstrate financial benefit regarding return on investment.

As we celebrate 18 months since the launch of the Swiss Journal of Radiology and Nuclear Medicine (www.SJORANM.com), it is both a privilege and an inspiration to reflect on the journey that has brought us to this significant milestone. Since its establishment in June 2023, the journal has rapidly grown into a dynamic platform that bridges disciplines, fosters innovation, and contributes to the global dialogue in radiology and nuclear medicine. Our presence extends beyond traditional boundaries, leveraging the reach of social media platforms such as YouTube, LinkedIn, X, TruthSocial, Facebook, Instagram, TikTok, and others. The rapidly growing number of followers on these channels underscores their potential as transformative tools for scientific communication. Unlike conventional publishing formats, these platforms enable the dissemination of scientific content not only through text but also via audio and video, offering unprecedented opportunities to engage and educate diverse audiences. This evolution mirrors other technological disruptions. Just as email rendered fax and postal mail obsolete within months of its inception, scientific publishing is poised for a similar transformation. The advent of low-cost, high-impact tools for creating and sharing content challenges the traditional publishing models, compelling established publishers to adapt or risk obsolescence. As we continue this journey, we remain committed to embracing innovation and fostering a collaborative, forward-thinking approach that ensures the Swiss Journal of Radiology and Nuclear Medicine remains at the forefront of scientific communication.

Background and Aims: Progression of type 2 diabetes (T2D) demands complex treatment modalities, which may impair patients’ confidence and psychological health. Technologies allowing improved understanding of the dynamic disease process may improve engagement with therapy. Methods: As part of a larger observational study, we previously reported findings highlighting the impact of using Dexcom G6 real-time CGM (rtCGM) with T2D adults (diverse therapies) and prediabetes over a 12-week period. We now explored qualitative data generated from a subsample of T2D participants (N=38) on non-intensive insulin therapy (Basal only=24%, No insulin=76%). Participants answered open-ended questions about their experiences using CGM including self-reported learnings and changes in behavior. Primary themes from qualitative data were derived using content analysis and confirmed with inter-coder reliability. Results: Overall, most participants (&amp;gt;90%) ended the study with high levels of perceived control (PC) of their diabetes. For further analysis, participants’ change in PC at study end were plotted based on low, medium, or high PC before CGM use. Interesting group differences emerged wherein fewer participants reporting medium PC at baseline reported high PC at study end (vs. others with low and high baseline PC). Qualitative themes around perceived illness severity, depressive symptoms, and self-efficacy along with differences in demographics and glycemic metrics helped translate these meaningful findings. Conclusions: rtCGM use provided valuable improvements in participants’ engagement and understanding of their diabetes with potential for long-term clinical benefits. Future studies exploring relationships between perceived control of diabetes and progression of T2D may indicate potential areas for improved engagement with diabetes technology. Disclosure M.A.Crawford: Employee; Dexcom, Inc. C.Hicks: Employee; Dexcom, Inc. P.Genge: Employee; Dexcom, Inc. K.Greenawald: Employee; Dexcom, Inc. M.Tressler: Employee; Dexcom, Inc. D.R.Cherñavvsky: None. H.Singh: Employee; Tandem Diabetes Care, Inc., Dexcom, Inc. Funding Dexcom, Inc.

Introduction: Mannose Binding Lectin (MBL) is a pattern recognizing molecule in the Lectin complement pathway and acts by activating the complement cascade via binding with ligands. There is evidence of increased autoreactivity of Mannose Binding Lectin in various diseases especially diabetes. MBL deficiency can reduce pathogen clearance and impair atherogenic lipoprotein removal whereas higher levels are associated with exaggerated immune response due to complement activation in the presence of hyperglycemia.&#x0D; Aims &amp; Objectives: This study aims to find out the association of MBL (Mannose Binding Lectin) with different clinical parameters in healthy controls and type 2 DM patients to predict disease outcome in type 2 diabetics. Mean level of MBL in type 2 diabetics and healthy population will be compared to characterize MBL levels amongst diabetics helping the clinicians to stratify patients according to disease severity.&#x0D; Place and duration of study: It was a cross sectional analytical study conducted at Chughtai Institute of Pathology from July 2019 to January 2020 on samples collected nationwide at Chughtai Lab collection centres.&#x0D; Material &amp; Methods: We selected 300 adult male and females in this study after taking informed consent based on strict inclusion and exclusion criteria. Of these 200 were known cases of type 2 diabetes mellitus and 100 healthy controls. .Fasting blood samples were drawn from both groups were analyzed for hs-CRP, HbA1c, creatinine, Total Cholesterol, Alanine amino transfer as (ALT), HDL-Cholesterol, LDL-Cholesterol, Glucose, Triglyceride, and Mannose Binding lectin. eGFR (Estimated Glomerular Filtration rate) was calculated for each patient and control. Data was analyzed via Graph Pad Prism 5 and SPSS version 23.0, p value ? 0.05 was taken as significant.&#x0D; Results: Mean age of the participants was 47.9 years in diabetic group and 39.3 years in healthy controls. The healthy population had a mean MBL level of 110.1 (SD±3.94) pg/ml and mean MBL level of diabetic group was 197.9 (SD±12.84) pg/ml (p&lt;0.05). No differences in MBL levels were detected based on gender distribution. There was a significant difference among HbA1c, LDL-C, HDL-C, Fasting Glucose, TG, creatinine and eGFR amongst the diabetic and the healthy group (p&lt;0.05). There was a negative correlation between MBL levels and plasma glucose and a positive correlation between the former and HDL-C in the healthy controls. In diabetic patients having MBL above 178pg/ml, a positive correlation of HbA1C with MBL was found. CRP in the healthy population resembled levels in patients with elevated MBL and the ratio Trig/HDL was higher in this subgroup having a positive correlation with MBL.&#x0D; Conclusion: MBL plays a role in pathophysiology of diabetes mellitus and elevated MBL having positive correlation with HbA1c might show association of glycemic control with the biomarker levels. A direct relationship of MBL with development of cardiovascular complications in type 2 diabetics was suggested by a positive association of MBL with TG to HDL-C ratio.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

IntroductionWith the expanding use of point-of-care ultrasound throughout medical specialties for the rapid bedside assessment integral to patient care, medical schools have sought to incorporate ultrasound education into their curriculum. Second-year medical students (MS2s) at our institution met this demand by forming the Ultrasound Student Instructor Cadre (USSIC), a longitudinal ultrasound curriculum where MS2s teach first-year medical students (MS1s). The objectives of this study were to assess the ultrasound knowledge of medical students and their perceptions of ultrasound incorporation into their medical education.MethodsOur flipped classroom curriculum consisted of four lessons (cardiopulmonary, gastrointestinal, genitourinary, and musculoskeletal) composed of videos, didactic lessons, and hands-on probe-time, with 15-minute pre- and post-assessments. Paired Wilcoxon signed-rank tests were performed to evaluate the differences in the pre- and post-assessment scores for each teaching session. Additionally, an end-of-the-year survey assessed the perceived preparedness and overall satisfaction of the MS1s with the course.ResultsThe differences between the pre- and post-assessments for each teaching session were statistically significant: cardiopulmonary (45.6 ± 16.9% vs. 82.9 ± 9.4%, p < 0.0001, n = 55), gastrointestinal (53.9 ± 18.0% vs. 84.1 ± 13.5%, p < 0.0001, n = 54), genitourinary (68.9 ± 19.1% vs. 91.4 ± 14.4%, p < 0.0001, n = 64), and musculoskeletal (33.6 ± 14.7% vs. 78.2 ± 18.2%, p < 0.0001, n = 55).ConclusionOur study suggests that MS1s met the learning objective for each teaching session. Furthermore, MS1s who became USSIC instructors as MS2s felt more prepared and were more satisfied with the course. This study demonstrates the efficacy of student-led instruction in ultrasound, and we offer our model for adoption into other medical schools.