Search

As anti-diversity, equity, and inclusion (DEI) legislation continues to gain traction, it is essential for those in science, technology, engineering, mathematics, and medicine (STEMM) to grasp its implications and explore ways to preserve inclusive environments. Anti-DEI measures can result in the dismantling of support structures, such as DEI centers and peer counseling groups, leading to a decline in vital support programs on college campuses and beyond. In this Voices article, we examine these emerging challenges and underscore the critical need to reframe DEI as a tool for fostering inclusion and benefits all individuals., Competing Interests: Conflicts of interest: The authors declare no financial conflict of interest.

Background: Identifying patient-, facility-, and environment-level factors that influence the initiation and retention of comprehensive lifestyle management interventions (CLMI) for urban and rural Veterans could improve obesity treatment and reach at Veterans Affairs (VA) facilities., Aims: This study identified factors at these various levels that predicted treatment engagement, retention, and weight management among urban and rural Veterans., Methods: A retrospective cohort study of 631,325 Veterans was designed using VA databases to identify Veterans with class II and III obesity during 2015-2017. Primary outcomes were initiation of CLMI, bariatric surgery, or obesity pharmacotherapy within 1 year of index date. Secondary outcomes included treatment retention and successful weight loss. Generalized linear mixed models were used to evaluate the relationships between factors and obesity-related outcomes, with rurality differences assessed through interaction terms., Results: Patient characteristics associated with increased odds of initiating CLMI included female sex ( p  < 0.001), black race ( p  < 0.001), sleep apnea ( p  < 0.001), mood disorder ( p  < 0.001), and use of medications associated with weight loss ( p  < 0.001) or weight gain ( p  < 0.001). Facility use of telehealth was associated with greater odds of CLMI initiation in urban Veterans ( p  < 0.001) but lower retention in both populations ( p  = 0.003). Routine consideration of pharmacotherapy was associated with higher CLMI initiation. Environmental characteristics associated with increased odds of CLMI initiation included percent of population foreign born (OR = 1.03 per 10% increase; p  < 0.001), percent black ( p  < 0.001), and high walkability index ( p  < 0.001). The relationship between total population and CLMI initiation differed by rurality, as greater population was associated with lower odds of CLMI initiation in urban areas (OR: 0.99 per 1000 population; p  < 0.001), but higher odds in rural areas (OR:1.01, p  = 0.01). Veterans in the south were less likely to initiate CLMI and had lower retention ( p  < 0.001)., Conclusion: Treatment and retention of CLMI among Veterans remain low, highlighting areas for improvement to expand its reach both urban and rural Veterans., Competing Interests: The authors declare no conflicts of interest statement., (Published 2024. This article is a U.S. Government work and is in the public domain in the USA. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.)

There is conflicting evidence in select mouse models and humans that suggest angiotensin-converting enzyme 2 expression is increased due to treatment with angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACEI/ARBs). Given the wide range of conditions that these medications treat, further evaluation is necessary to determine safety in the context of COVID-19. We sought to determine the association between use of ACEI/ARBs and COVID-19 severity in patients with essential hypertension. We included 714 patients with essential hypertension diagnosed with COVID-19 and admitted to University of Iowa Healthcare from March 1, 2020 to June 29, 2021. Severity of COVID-19 infection was assessed based on mortality, length of stay in hospital, intensive care unit admission, and use of supplemental oxygen, invasive ventilation, and vasopressors. Multivariable logistic and linear regression analyses were used for binary and continuous outcomes, respectively. Prior exposure to ACEI/ARBs before admission was significantly associated with lower mortality (OR: 0.454, p = .015), shorter length of stay in hospital (p < .001), and decreased adjusted odds of intensive care admission (OR: 0.719; p < .042). The present results suggest that patients with essential hypertension hospitalized with COVID-19 who had a prescription for ACEI/ARBs prior to admission exhibited less severe COVID-19 and lower in-hospital mortality., (© 2024 The Author(s). The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

In academia, particularly in science, technology, engineering, and mathematics (STEM), writing accountability groups have emerged as an effective technique to enhance writing productivity by offering structure, increasing the commitment to write, and fostering social commitment. The rapid development of technology has introduced a new challenge across STEM fields: technostress, where individuals face heightened stress due to novel applications of technology. To address this, we introduce Technology Accountability Groups (TAGs), a novel form of community support for graduate students and faculty. TAGs are tailored to help individuals navigate technological innovations, alleviate technostress, acquire new skills, motivate, and connect with leaders in the field. This paper presents a framework for establishing, implementing, and sustaining TAGs in STEM., (© 2024 The Author(s). Journal of Cellular Physiology published by Wiley Periodicals LLC.)

A first-generation college student is typically defined as a student whose biological parent(s) or guardian(s) never attended college or who started but did not finish college. However, "first-generation" can represent diverse family education situations. The first-generation student community is a multifaceted, and intersectional group of individuals who frequently lack educational/financial resources to succeed and, consequently, require supportive environments with rigorous mentorship. However, first-generation students often do not make their identity as first-generation students known to others due to several psychosocial and academic factors. Therefore, they are often "invisible minorities" in higher education. In this paper, we describe the diverse family situations of first-generation students, further define "first-generation," and suggest five actions that first-generation trainees at the undergraduate/graduate stages can engage in to succeed in an academic climate. We also provide suggestions for mentors to accommodate first-generation students' unique experiences and equip them with tools to deliver intentional mentoring practices. We hope that this paper will help promote first-generation student success throughout the academic pipeline., (© 2024 Wiley Periodicals LLC.)

Introduction: Medical curricula implicitly teach that race has a biological basis. Clinical rotations reinforce this misconception as race-based algorithms are used to guide clinical decision-making. This module aims to expose the fallacy of race in clinical algorithms, using the estimated glomerular filtration rate (eGFR) equation as an example., Methods: We created a 60-minute module in consultation with nephrologists. The format was an interactive, case-based presentation with a didactic section. A third-year medical student facilitated the workshops to medical students. Evaluation included pre/post surveys using 5-point Likert scales to assess awareness regarding use of race as a biological construct. Higher scores indicated increased awareness., Results: Fifty-five students participated in the module. Pre/post results indicated that students significantly improved in self-perceived knowledge of the history of racism in medicine (2.6 vs. 3.2, p < .001), awareness of race in clinical algorithms (2.7 vs. 3.7, p < .001), impact of race-based eGFR on quality of life/treatment outcomes (4.5 vs. 4.8, p = .01), differences between race and ancestry (3.7 vs. 4.3, p < .001), and implications of not removing race from the eGFR equation (2.7 vs. 4.2, p < .001). Students rated the workshops highly for quality and clarity., Discussion: Our module expands on others' work to expose the fallacy of race-based algorithms and define its impact on health equity. Limitations include a lack of objective assessment of knowledge acquisition. We recommend integrating this module into preclinical and clinical curricula to discuss the use of race in medical literature and clinical practice., (© 2024 Kamalumpundi et al.)

Objective: Characterize antibiotic prescribing behaviors at an Indian palliative care center after the initiation of the Antibiotic Order Form (AOF): an antibiotic stewardship program involving a paper form to track antibiotic use and to provide prescription guidelines., Design: Retrospective chart review., Setting: Trivandrum Institute of Palliative Sciences (TIPS) is a palliative care organization in Kerala, India., Methods: Antibiotic prescription data and patient data were collected for adult patients treated at TIPS between January 1, 2017, and October 31, 2019. Descriptive statistics and a Zero-Inflated Poisson regression model were used to analyze antibiotic prescriptions. AOF completion and prescription concordance with institutional guidelines were also evaluated., Results: Out of 7,450 unique patients, 675 (9%) were prescribed 1,448 antibiotics. Age was the strongest factor in determining the number of antibiotic courses with each additional year of age decreasing the expected antibiotic prescription count by 2% per year. The most common antibiotics prescribed were topical metronidazole (44%) and penicillins (29%). Among patients who died, 5% were prescribed antibiotics within the final month of life. In total, 32% of antibiotic prescriptions were documented in AOFs, and 18% were concordant with all institutional antibiotic prescribing guidelines., Conclusions: This study is the first to analyze an antibiotic stewardship intervention in a palliative care setting within a low- and middle-income country. This retrospective study provides a benchmark of antibiotic use within Indian palliative care and highlights areas for future stewardship research including topical metronidazole use within palliative care and higher rates of antibiotic use among younger palliative care patients., Competing Interests: All authors report no conflicts of interest related to this article., (© The Author(s) 2023.)

Despite tremendous diversity, Asian Americans in STEM are grouped and viewed as a homogeneous monolith, facing stereotypes and disparities. We propose solutions that include disaggregating the Asian American grouping and recognizing the diverse individual ethnic subgroups that comprise Americans of Asian ancestry to implement change within the STEM field., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Angiotensin receptor blockers (ARB) and angiotensin-converting enzyme inhibitors (ACEI) increase the expression of ACE2, which is a receptor for entry of SARS-CoV-2 into cells. Though evidence suggests that ARB/ACEI are safe among the general population with COVID-19, their safety in patients with overweight/obesity-related hypertension deserves further evaluation., Objective: We assessed the association between ARB/ACEI use and COVID-19 severity in patients with overweight/obesity-related hypertension., Methods: This study included 439 adult patients with overweight/obesity (body mass index ≥ 25 kg/m2) and hypertension, diagnosed with COVID-19 and admitted to University of Iowa Hospitals and Clinic from March 1 to December 7, 2020. Mortality and severity of COVID-19 were evaluated based on length of stay in hospital, intensive care unit admission, use of supplemental oxygen, mechanical ventilation, and vasopressors. Multivariable logistic regression was used to examine the associations of ARB/ACEI use with mortality and other markers of COVID-19 severity, with a two-sided alpha set at 0.05., Results: Exposure to ARB (n = 91) and ACEI (n = 149) before hospitalization was significantly associated with lower mortality (odds ratio [OR] = 0.362, 95% confidence interval [CI] 0.149 to 0.880, p = 0.025) and a shorter length of stay (95% CI -0.217 to -0.025, p = 0.015). Additionally, patients using ARB/ACEI showed a non-significant trend toward lower intensive care unit admission (OR = 0.727, 95% CI 0.485 to 1.090, p = 0.123), use of supplemental oxygen (OR = 0.929, 95% CI 0.608 to 1.421, p = 0.734), mechanical ventilation (OR = 0.728, 95% CI 0.457 to 1.161, p = 0.182), and vasopressors (OR = 0.677, 95% CI 0.430 to 1.067, p = 0.093)., Conclusion: Results suggest that hospitalized patients with COVID-19 and overweight/obesity-related hypertension who were prescribed ARB/ACEI before admission to the hospital exhibit lower mortality and less severe COVID-19 than those who were not taking ARB/ACEI. The results also suggest that exposure to ARB/ACEI may protect patients with overweight/obesity-related hypertension from severe COVID-19 and death.

Diversity, equity, and inclusion (DEI) initiatives are critical for fostering growth, innovation, and collaboration in science, technology, engineering, mathematics, and medicine (STEMM). This article focuses on four key topics that have impacted many Black individuals in STEMM: know-your-place aggression, environmental microaggressions, peer mediocrity, and code-switching. We provide a comprehensive background on these issues, discuss current statistics, and provide references that support their existence, as well as offer solutions to recognize and address these problems in the STEMM which can be expanded to all historically underrepresented individuals., Competing Interests: Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Here, we provide an in-depth analysis of the usefulness of single-sample metabolite/RNA extraction for multi-'omics readout. Using pulverized frozen livers of mice injected with lymphocytic choriomeningitis virus (LCMV) or vehicle (Veh), we isolated RNA prior (RNA) or following metabolite extraction (MetRNA). RNA sequencing (RNAseq) data were evaluated for differential expression analysis and dispersion, and differential metabolite abundance was determined. Both RNA and MetRNA clustered together by principal component analysis, indicating that inter-individual differences were the largest source of variance. Over 85% of LCMV versus Veh differentially expressed genes were shared between extraction methods, with the remaining 15% evenly and randomly divided between groups. Differentially expressed genes unique to the extraction method were attributed to randomness around the 0.05 FDR cut-off and stochastic changes in variance and mean expression. In addition, analysis using the mean absolute difference showed no difference in the dispersion of transcripts between extraction methods. Altogether, our data show that prior metabolite extraction preserves RNAseq data quality, which enables us to confidently perform integrated pathway enrichment analysis on metabolomics and RNAseq data from a single sample. This analysis revealed pyrimidine metabolism as the most LCMV-impacted pathway. Combined analysis of genes and metabolites in the pathway exposed a pattern in the degradation of pyrimidine nucleotides leading to uracil generation. In support of this, uracil was among the most differentially abundant metabolites in serum upon LCMV infection. Our data suggest that hepatic uracil export is a novel phenotypic feature of acute infection and highlight the usefulness of our integrated single-sample multi-'omics approach.

Type 2 diabetes is often complicated with hypertension, such that 73.6 % of patients ≥ 18 years with type 2 diabetes also have hypertension. With increasing age, the risk of developing these conditions rises significantly. Co-existence of type 2 diabetes and hypertension suggests that there are overlapping genetic, physiologic, and environmental factors at play. Research has shown several overlying metabolic abnormalities including sympathetic nervous system overactivation, insulin resistance, inflammatory and endothelial dysfunction, deleterious expression of microRNAs, and obstructive sleep apnea. Though diet and physical activity are the mainstays of treatment early in the disease course, they are generally not a viable long-term strategy. Treatment with novel hypoglycemic and anti-hypertensive medications can greatly assist in preventing long-term complications of these chronic conditions. Recognition of the common causes and consequences of type 2 diabetes and comorbid hypertension allows for a robust response towards being proactive regarding prevention and treatment of this unique patient population. Thus, the purpose of this current review is four-part: to (1) review the latest discoveries into the mechanisms of hypertension in the setting of type 2 diabetes, (2) discuss the latest treatments of hypertension with a brief discussion about novel hypoglycemic agents in patients with type 2 diabetes, (3) summarize blood pressure targets and (4) to address evidence gaps in treating patients with diabetes and resistant hypertension, and elderly individuals with both hypertension and diabetes., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Marcelo Correia is a consultant for Novo Nordisk Inc. and receives research grants from Novo Nordisk Inc., Novartis International AG, and Eli Lilly Co. All other authors declare no conflict of interests with regards to the work described in this manuscript.]., (Copyright © 2022. Published by Elsevier Inc.)

The prevalence of obesity has increased two to three times from 1975 to 2015. Large-scale epidemiological and longitudinal prospective studies link obesity with hypertension. Research suggests that excessive weight gain, particularly when associated with visceral adiposity, may account for as much as 65% to 75% of the risk of incident hypertension. Also, exercise and bariatric/metabolic surgery significantly lowers blood pressure, whereas weight gain increases blood pressure, thus establishing a firm link between these two factors. The mechanisms underpinning obesity-related hypertension are complex and multifaceted, and include, but are not limited to, renin-angiotensin-aldosterone system/sympathetic nervous system overactivation, overstimulation of adipokines, insulin resistance, immune dysfunction, structural/functional renal, cardiac, and adipocyte changes. Though weight loss is the mainstay of treatment for obesity-related hypertension, it is often not a feasible long-term solution. Therefore, it is recommended that aggressive treatment with multiple antihypertensive medications combined with diet and exercise be used to lower blood pressure and prevent complications. The research regarding the mechanisms and treatment of obesity-related hypertension has moved at a blistering pace over the past ten years. Therefore, the purpose of this expert review is two-fold: to discuss the pathophysiological mechanisms underlying obesity-related hypertension, and to revisit pharmacotherapies that have been shown to be efficacious in patients with obesity-related hypertension., (© 2021. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.)

Purpose: This review aims to critically evaluate the efficacy of web or mobile-based (WMB) interventions impacting emotional symptoms in patients with advanced cancer., Method: Articles published from 1991 to 2019 were identified using PubMed, PsycINFO, CINAHL, and Scopus. Only interventions involving adults with advanced cancer using a WMB intervention to manage emotional symptoms were included. Risk of bias was assessed using ROBINS-I and ROB2 tools. Studies that reported mean symptom scores were pooled using a random-effects model, and standardized mean difference (SMD) and 95% CIs were calculated., Results: Twenty-three of the 1177 screened studies met the inclusion criteria, and a total sample of 2558 patients were included. The sample was 57% female, and 33% had advanced cancer with mean age of 57.15 years. Thirteen studies evaluated anxiety, nineteen evaluated depression, and eleven evaluated distress. Intervention components included general information, tracking, communication, multimedia choice, interactive online activities, tailoring/feedback, symptom management support content, and self-monitoring. Overall pooled results showed that WMB interventions' effects on decreasing anxiety (SMD - 0.20, - 0.45 to 0.05, I 2  = 72%), depression (SMD - 0.10, - 0.30 to 0.11, I 2  = 73%), and distress (SMD - 0.20, - 0.47 to 0.06, I 2  = 60%) were not significant for randomized controlled trials (RCTs). In contrast, WMB interventions significantly decreased symptoms of anxiety (p = .002) in a sub-group analysis of non-RCTs., Conclusion: This meta-analysis demonstrated that WMB interventions were not efficacious in alleviating emotional symptoms in adults with advanced cancer. Considering the diversity of interventions, the efficacy of WMB interventions and its impacts on emotional symptoms should be further explored., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Palliative and end-of-life care has been pushed to the forefront of medical care during the pandemic caused by the coronavirus-2019 (COVID-19). Palliative care organizations have responded to the growing demand for the rapid dissemination of research, clinical guidance, and instructions for care to clinicians, patients with COVID-19, and their caregivers by creating COVID-19 resource Web pages. Here, end users can access resources that can be updated in real time. These Web pages, however, can be variable in what resources they offer and for whom they are designed for (clinicians, patients, caregivers). Therefore, this project was conducted to consolidate these resources via summary tables of specific contents available through each Web page grouped by palliative care domains (eg, care discussion and planning, communication, symptom management, care access) and to identify the target audience. This environmental scan was conducted by compiling a comprehensive list of COVID-19 resource Web pages of palliative care organizations generated by reviewing previously published research studies and consulting with palliative care research experts. Snowballing techniques were used to identify resource Web pages not captured in the initial scan. Two reviewers independently evaluated eligible Web pages for content via a form developed for the study, and Cohen κ statistic was calculated to ensure interrater reliability. The final κ statistic was 0.76. Of the 24 websites screened, 15 websites met our eligibility criteria. Among the eligible resource Web pages, most (n = 12, 80%) had specific target audiences and care settings, whereas the rest presented information targeted to all audiences. Although 11 Web pages offered resources that addressed all 4 domains, only 1 Web page conveyed all 12 subdomains. We recommend the use of this guide to all frontline clinicians who require guidance in clinically managing patients with COVID-19 receiving palliative care and/or end-of-life care., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 by The Hospice and Palliative Nurses Association. All rights reserved.)

Background: Symptom management is a critical aspect of comprehensive palliative care for people with advanced cancer. Web and mobile-based applications are promising e-Health modalities that can facilitate timely access to symptom management interventions for this population., Aim: To evaluate the efficacy of web and mobile-based symptom management interventions in alleviating physical symptom burden in people with advanced cancer., Design: A systematic review and meta-analysis was conducted. PROSPERO ID = CRD42020155295., Data Sources: We searched databases including PubMed, PsycINFO, and CINAHL from 1991 until 2019. Inclusion criteria were: adults with advanced cancer, web or mobile-based interventions targeting symptom management, and report of physical symptom data. Risk of bias was assessed using the ROBINS-I and RoB2. Using RevMan, standardized mean difference (SMD) and 95% confidence intervals were calculated. Heterogeneity was assessed using the I 2 statistic. An assessment of interventions was conducted by evaluating the delivery mode, duration, and evaluation of application feature and theoretical elements., Results: A total of 19 studies are included in the systematic review and 18 in the meta-analysis. Majority of the studies were deemed to have high risk of bias. Most of the interventions used a web-application for delivering their education ( n  = 17). While the interventions varied regarding duration and content, they were mainly guided by a symptom management theory. Web and mobile-based interventions significantly improved the overall physical symptom burden (SMD = -0.18; 95% CI = -0.28 to -0.09; I 2  = 0%; p  = 0.0002)., Conclusions: Web and mobile-based intervention are efficacious in decreasing the overall physical symptom burden in people with advanced cancer.