Complete Screening Research Articles

Increasing Screening for Sexually Transmitted Infections Among Adolescents and Young Adults Diagnosed With Sickle Cell Disease: A Quality Improvement Project

BackgroundSexually transmitted infections affect 20 million adolescents and young adults in the United States annually. Local ProblemIn a pediatric outpatient sickle cell disease clinic, in southeastern, US, 16% (43/272) of patients aged 16-24 had a documented sexual health history and 12% (4/77) completed STI screenings. The clinic's aim was to increase sexual health assessment, STI screenings, diagnosis, and treatment. Methods/InterventionUsing process redesign, a standardized sexual health and STI screening process at routine visits was implemented to increase completion of sexual health histories and STI screening. ResultsSexual health history collection rates increased from 16% (43/272) pre- to 92% (107/116) post-intervention. The rate of STI testing offered increased from 12% (5/43) pre- to 100% (116/116) post-intervention. The STI testing rates increased 22.5 % from 40% (2/5) pre- to 49% (20/41) post-intervention. ConclusionsEvidence-based standardized interventions can successfully be used to assist in sexual health documentation and STI screening.

Abstract 22: Implementation of increased physical therapy intensity for improving walking across inpatient stroke rehabilitation units: Primary results of the Walk ‘n Watch multi-site stepped-wedge cluster randomized controlled trial

Introduction: Though clinical practice guidelines support high repetitions of walking after stroke, practice is slow to change with low levels of walking activity in stroke rehabilitation units. We undertook an implementation trial to change practice; we enabled entire stroke units to use the Walk ‘n Watch protocol and determined the effect of implementation on the 6 Minute Walk Test (6MWT) at hospital discharge. Methods: This 12-site clinical trial across 7 Canadian provinces used a stepped-wedge cluster design to randomize when each site switched from Usual Care to the Walk ‘n Watch protocol. At the start of the Walk ‘n Watch phase, we trained all front-line physical therapists on the unit with training workshops, manuals, hands-on practice, and videos. Each site was provided onboarding materials to address staff changes so therapists who did not attend the initial training could adopt the protocol. Each site also identified a ‘protocol champion’ to facilitate initial weekly huddles with therapists to discuss barriers to implementation. Therapists were trained to complete safety screening and to determine eligibility. The Walk ‘n Watch protocol focused on completing a minimum of 30-minutes of daily weight-bearing, walking-related activities that progressively increased in intensity informed by activity trackers measuring heart rate and step number. Blinded assessors completed the outcomes at baseline and 4-weeks later (near discharge). Primary analysis used a linear mixed-effects model adjusted for stratum, date of enrollment, age, sex and baseline 6MWT. Results: The total number of participants was 306 (162 Usual Care, 144 Walk ‘n Watch, 188 males/118 females) with a mean(SD) age of 68(13), 29(17) days since stroke, and a baseline 6MWT of 152(106) m. The improvement on the 6MWT was 43.6m (95%CI 12.7, 76.1) greater in the Walk ‘n Watch group compared to the Usual Care group. Further, the Walk ‘n Watch group improved quality of life (EQ5D), balance and mobility (Short Physical Performance Battery) and gait speed. Conclusions: The implementation trial design enabled the protocol to be tested under real-world conditions, involving all therapists on each unit to deliver the protocol. The trial had a deliberate aim to facilitate changes in practice that resulted in clinically meaningful improvements in walking and quality of life.

158. Hepatitis B Screening Among Persons With HIV Receiving Care from the U.S. Department of Veterans Affairs

Abstract Background In the United States, around 8% of persons with HIV (PWH) are coinfected with Hepatitis B (HBV), influencing antiretroviral choice and conferring higher mortality. Despite recommendations for universal HBV screening in PWH, small US and international studies found 52-68% were ever screened. National US data on HBV screening in PWH that could inform quality improvement efforts is lacking. Hepatitis B Screening in Persons with HIV Receiving Care in the US Veterans Health Administration Methods We used the Veterans Health Administration (VHA) Corporate Data Warehouse to conduct a service evaluation of longitudinal operational data collected during routine care in the integrated electronic health record. We assessed the proportion of PWH receiving HIV care through VHA (at least one encounter in the current or previous year) who have complete HBV serologic screening, defined as at least one result for each of hepatitis B surface antigen (sAg), core antibody (cAb) and surface antibody (sAb). We conducted two multivariate logistic regressions on complete HBV serologic screening using (1) demographic and comorbidity variables, and (2) geographic and facility variables. Hepatitis B Screening Amongst Persons with HIV by Geographic and Facility Factors Results Of 30,412 PWH receiving VHA care, 24,913 (81.9%) had complete HBV serologic screening. Adjusted odds ratios (AOR) for complete HBV screening were significantly higher in PWH who were black or Hispanic, born from 1961 onwards, were homeless, or had comorbidities such as hepatitis C, mental health and substance use disorders, as shown in Table 1, but did not differ significantly by sex. AOR for complete HBV screening were significantly lower for PWH seen at rural and lower complexity (smaller) facilities as shown in Table 2. Among non-immune PWH without hepatitis B (sAg negative, no prior reactive sAg), 55% subsequently received at least 1 dose of hepatitis B vaccine after a median 370-day interval (IQR 75-1512) as shown in Figure 1. Time to Administration of At Least One Dose Of Hepatitis B Vaccine in Persons with HIV with Negative Hepatitis B Surface Antigen Lacking Prior Positive Surface Antibody Results. Conclusion Our data provide insight into current HBV screening practices for PWH in a nationwide US health system. Overall HBV screening rates were high, but 18.1% of PWH had incomplete HBV screening with cAb most frequently missing. Lower odds of HBV screening in smaller facilities and rural populations underscore the need for tailored strategies to ensure equitable access. Our data will inform quality improvement efforts to enhance screening practices for HBV among Veterans living with HIV. Disclosures All Authors: No reported disclosures

212. Gonorrhea and Chlamydia Opt-Out Screening of Justice-Involved Females During Intake at the Los Angeles County Jail: The Pivotal Role of Correctional Health Systems

Abstract Background Chlamydia and gonorrhea are two of the most common sexually transmitted infections (STIs) worldwide, presenting major public health challenges and resulting in billions of dollars in direct medical costs in the U.S. Incarcerated females have a particularly elevated risk of these infections, which can result in significant clinical and public/community health-level sequelae if left untreated. On December 13, 2021, the division of Correctional Health Services began offering opt-out urogenital chlamydia and gonorrhea screening to all newly incarcerated females within the Los Angeles County Jail system. Methods We retrospectively analyzed electronic health record data for completed urogenital chlamydia/gonorrhea screening among newly incarcerated females between December 13, 2021, and May 31, 2023. We used multivariable logistic regression to examine the association of STIs and treatment non-initiation outcomes with various demographic and self-reported variables. Results Of the 13739 women offered STI testing, 10717 (78%) completed screening, with 1151 (11%) having a chlamydial infection, 788 (7%) having a gonococcal infection, and 1626 (15%) having either infection. In a multivariable model, result positivity was associated with age 18-34, reported houselessness, amphetamine use, and history of a positive prior treponemal antibody test. STI treatment non-initiation was associated with shorter length of stay for both chlamydial ([aOR] = 87.4, 95% CI (34.2, 223.2)) and gonococcal ([aOR] = 9.0, 95% CI (5.2, 15.7)) infections. Conclusion The STI screening and prevalence among female detainees tested at intake was many-fold higher than that of the general population. The implementation of routine opt-out STI screening and treatment of STI-infected people in carceral settings provides a unique and important opportunity to benefit the health of this high-risk population and has the potential to create a spillover effect that might benefit the surrounding community. Disclosures Loren G. Miller, MD MPH, Armata: Grant/Research Support|Contrafect: Grant/Research Support|GSK: Grant/Research Support|Merck: Grant/Research Support|Paratek: Grant/Research Support

P-1440. Are Veterans Willing to Complete Sexual Health Screening In Primary Care?: Lessons Learned from a Population Level Sexual Health Questionnaire

Abstract Background The CDC recommends routine sexual histories (SH), yet they are rarely completed in primary care (PC) due to barriers ranging from patient discomfort to provider time constraints. We implemented a system wide nurse-led sexual health screening tool at a large VA hospital. Here we report on patient acceptability of sexual histories and sexual behaviors of Veterans at a population level.Table 1Demographics, Overall by Question 1 ResponseThis table describes demographics of those who agreed to discuss their sexual health, ie said Yes to Question 1 Methods We deployed a short SH screening questionnaire to be conducted during PC visits. Administered mostly by nurses, the questionnaire began with a consent question. Those with an affirmative response proceeded to answer additional questions. We queried the VA’s electronic database to ascertain patient demographics including age, birth sex, sexual orientation, gender identity, race/ethnicity, Rural-Urban Commuting Area codes. We describe the population as medians and proportions.Table 2Demographics, Overall by Question 2 ResponseThis table describes demographics of those who agreed to discuss about sexual health and have more than one sexual partner, ie said Yes to Question 2 Results Over 2-years (April 14, 2022-24) 130,986 SH screening questionnaires were offered to 95,490 unique Veterans, with 83,510 (87%) agreed at least once (Table 1). Birth sex females were more likely than males to agree to SH (91% vs. 87%). Most 65 and older agreed to the screening (85%). Supermajority of Veterans who have recorded a sexual identity as LGBQ+ agreed to SH (1688/1798, 94%). Similarly, 96% of those who have recorded self-identified gender as transgender man, transgender woman, or non-binary also agreed to SH. Racial or ethnic minority patients were more likely to agree to SH than Whites: 90% Black vs. 87% White; 91% vs. 87% non-Hispanic. Of 83,510 patients who agreed, 2754 (3%) had more than 1 sexual partner in the last 6 months, with younger age, LGBQ+ identity, Black race and Hispanic ethnicity associated with likelihood of more than 1 sexual partner (Table 2). Of these, 4% reported sexual partners of more than 1 gender, and 21% of this subset had a self-described sexual orientation as straight or heterosexual. Sexual Health Questions Conclusion A brief SH screening questionnaire administered by nurses in PC settings is feasible and highly acceptable to patients. Patients who identify as minority racial, ethnic, sexual or gender identity groups are very willing to provide SH, in some cases at much higher rates than non-minority peers. Other healthcare systems can implement similar nurse-led screening tools to improve SH taking in PC settings Age Breakdown for Question 1 This table describes the age breakdown for those who said Yes to Question 1, indicating both young and old population agree to discuss about sex. Disclosures All Authors: No reported disclosures

P-797. Household Contact Tuberculosis Screening Experience and Predictors of Tuberculosis Disease Diagnosis in Rural Tanzania

Abstract Background One third of people with TB disease (PWTB) remain undiagnosed, experiencing prolonged illnesses before diagnosis. To close this gap, the World Health Organization and national guidelines recommend TB screening for all household contacts (HHCs) of index PWTB. HHC TB screening experiences vary between countries, and between rural and urban parts within the same country. Therefore, we aimed to characterize the HHC TB screening and explore predictors of TB disease diagnosis among HHCs in Rural Tanzania. Methods We used data from a prospectively enrolled cohort of index PWTB and their HHCs in Haydom, Tanzania. We describe the testing recommended as part of HHC TB screening and use a multivariate regression model to explore predictors of TB disease diagnosis. Results The cohort enrolled 120 index PWTB with 398 HHCs. 261 HHCs (66%) from 85 households completed TB screening with sputum and chest x-ray recommended for 121 (46%) and 3 (1%) HHCs respectively. 18 HHCs (4.5%) were diagnosed with TB disease, 14 of them with no sputum or CXR recommended. HHCs with TB symptoms and HHCs of index PWTB with pulmonary TB or HIV were more likely to be diagnosed with TB. Only 10 HHCs completed six-months of daily isoniazid TPT out of 61 HHCs who started TPT (16.3%) and 79 HHCs who were eligible (12.7%). Conclusion The recommended sputum and imaging studies to complete HHC TB screening and short TPT regimens have suboptimal penetration in this rural high-burden setting. Innovative testing and coverage modalities are needed to bridge the gap. Disclosures All Authors: No reported disclosures

A Community Initiative to Increase Colorectal Cancer Knowledge, Awareness, and Intent to Screen in an Underserved Region.

Background: Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the United States despite the availability of effective preventive screening. Objective: This project was designed as a community awareness initiative to increase CRC awareness, knowledge, and intent to discuss and complete CRC screening. Methodology: This quasi-experimental study had a QI focus and used a convenience sample in a public setting assessing CRC awareness, knowledge, and intent to discuss and complete screening after participating in an inflatable colon tour. Results: CRC awareness and knowledge scores showed a statistically significant increase in posttest scores at p < .001. Posttour, there was an 82% and 133% increase in people who identified as "very likely" or "definitely" willing to discuss CRC with their healthcare provider and complete CRC screening within the next 6 months, respectively. Conclusions: In line with previous studies, the inflatable colon model was a successful means of increasing CRC knowledge, awareness, and intent to complete CRC screening. Implications for Nursing: This project is evidence that community events can successfully increase knowledge in underserved populations. Implementing community-based interactive education, such as an inflatable colon tour, is an effective way to incorporate evidence-based education for vulnerable populations.

Pre-injury narcotic drug use in isolated severe traumatic brain injury: effect on outcomes.

The aim of this study was to explore the association between pre-injury narcotic drug use (opioids, methadone, and/or oxycodone) and outcomes in isolated severe traumatic brain injury (TBI) patients. ACS TQIP study included adult trauma patients (≥ 16 years) with complete drug and alcohol screening. Isolated severe TBI was defined as head trauma with AIS 3-5 and without significant extracranial trauma. Exact matching was used to compare patients with isolated pre-injury narcotic drug use to those with no illicit drug or alcohol use. Patients were matched 1:1 based on the following matching criteria: age, gender, mechanism of injury, Injury Severity Score, systolic blood pressure, head AIS, and comorbidities. Of 1,846,630 patients, 141,058 had isolated severe head injuries with complete drug and alcohol screenings. After exact matching, 1,560 patients in each group were analyzed. There were no significant differences in hospital mortality, craniectomy rates, complication rates, or length of hospital stay. Patients that tested positive for narcotics had lower rates of mechanical ventilation (16.5% vs. 25.3%, p < 0.01) and shorter ICU stays [3 (2-4) days vs. 3 (2-6) days; p < 0.01]. Pre-injury narcotic drug use in isolated severe TBI is not associates with adverse outcomes. Further research is needed to understand the biochemical and physiological effects of narcotic drugs on TBI outcomes.

A systematic review of the effectiveness of leaded glasses for ensuring safety among healthcare professionals in fluoroscopy.

Currently, there is an increase in procedures across various clinical specialties involving the use of ionising radiation. The primary objective of this systematic review is to analyse and compare the existing literature regarding the effectiveness of leaded glasses for healthcare professionals. Comprehensive literature searches were conducted for relevant studies published between 2018 and 2023 using the Scopus, PubMed, and Web of Science databases according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. After the complete text screening, 11 articles were deemed suitable for inclusion in the review. Leaded glasses significantly reduce eye radiation exposure, with studies showing shielding effects ranging from 10 % to 88,9 %, depending on the configuration and thickness of the glasses. For instance, lightweight glasses achieved a shielding effect of 61.4 %, while thicker lead equivalents (≥0.5 mm) offered up to ninefold dose reductions. Studies also noted the importance of lateral shielding and ergonomic designs for optimal protection. Leaded glasses significantly reduce eye lens doses but are most effective when combined with other protective measures. Factors such as head orientation, procedural complexity, and operator movement influence their performance. The findings underscore the need for standardised guidelines on protective eyewear use and further research under real-world clinical conditions. It is essential to ensure the proper use of leaded glasses to minimize the risks of ionising radiation for healthcare professionals in fluoroscopy procedures.

PREVALENCE AND RISK FACTORS ASSOCIATED WITH HEPATITIS B VIRUS INFECTION AMONG ONCOLOGY PATIENTS

Background and aims: Hepatitis B virus (HBV) screening for patients with newly diagnosed solid cancer is not standard practice in oncology, and authorities disagree on whether complete screening should be carried out. Additionally, research on the risk factors for HBV infection in this patient population may differ from that in the general population. Therefore, estimating the prevalence of HBV and risk factors for HBV infection in individuals with recently diagnosed solid cancer was the study's goal. Subjects and methods: Newly diagnosed cancer patients at the oncology center of Al-Jumhori Hospital in Sana'a, are included in this cross-sectional study. A regular questionnaire created specifically for this study was used to gather data, which included demographic information, risk factors, cancer type, and test findings. Using an ELISA assays for HB surface antigen and HB Core IgG anti-antibodies were conducted. Results: The study analyzed 300 cancer patients with HBV testing, with a mean age of 42.9 years and a sex distribution of 37.6% men and 62.4% women. The crude HBV prevalence was 5%, with females having a higher prevalence. The study found no significant association between age, rural residency, married status, blood transfusion frequency, or blood sources with HBV risk. No association was found between under treatment chemotherapy and HBV infection. Conclusions: This study examines the frequency of HBV infections in patients with solid tumors for the first time in Yemen. Our study found that the nationwide prevalence of HBV was higher in cancer patients than in the broad population. Peer Review History: Received 15 October 2024; Reviewed 7 November; Accepted 21 December; Available online 15 January 2025 Academic Editor: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10

Beyond Genes: The Social Dimensions of Inborn Errors of Immunity

nborn errors of immunity (IEIs) necessitate a well-funded healthcare system and substantial financial resources for diagnosis and treatment. More than that, these diseases and socioeconomic status are inversely related. Immune deficiencies are better managed by those with higher socioeconomic position, but the emotional and financial tolls of living with a compromised immune system can be devastating for patients and their families, causing them to struggle financially for years to come. For a long time, the patient and people close to her are impacted by these conditions. Conversely, the national healthcare system and patients' socioeconomic situation determine the likelihood of early diagnosis and successful treatment. Development of the immune system throughout infancy is really crucial. Fetal development is regulated by maternal nutrition, psychological stress, the mother's mental health, and supporting social networks. The immune system develops from conception and matures during neonatal and early childhood. Effective IEI management and therapy require genetic and social factors to interact. Geneticists, immunologists, healthcare providers, and politicians must collaborate to address IEIs. Insufficient resources for complete newborn screening and genetic testing for all patients make treating the increased incidence of autosomal recessive and genetic diseases in MENA problematic. Primary immunodeficiency treatments including stem cell transplantation and gene therapy are limited in Latin America and Africa. Parental comprehension, awareness, and attitudes of PID genetic testing depend on service accessibility, familial history, and individual circumstances. Patients resist genetic therapy due to financial constraints, notably the high cost of genetic testing. Hematopoietic stem cell transplantation (HSCT) may treat nonmalignant lymphohematopoietic diseases, myeloid and lymphoid malignancies, immunological deficits, genetic disorders, and inborn metabolic problems. Improving PID outcomes requires correcting these discrepancies. This review aims to underscore the critical need for heightened awareness and improved diagnostic methods for IEIs by analyzing the interplay between genetic factors and societal influences.

High-throughput protein binder discovery by rapid in vivo selection.

Proteins that selectively bind to a target of interest are foundational components of research pipelines 1,2 , diagnostics 3 , and therapeutics 4 . Current immunization-based 5,6 , display- based 7-14 , and computational approaches 15-17,18 for discovering binders are laborious and time- consuming - taking months or more, suffer from high false positives - necessitating extensive secondary screening, and have a high failure rate, especially for disordered proteins and other challenging target classes. Here we establish Phage-Assisted Non-Continuous Selection of Protein Binders (PANCS-binders), an in vivo selection platform that links the life cycle of M13 phage to target protein binding though customized proximity-dependent split RNA polymerase biosensors, allowing for complete and comprehensive high-throughput screening of billion-plus member protein variant libraries with high signal-to-noise. We showcase the utility of PANCS- Binders by screening multiple protein libraries each against a panel of 95 separate therapeutically relevant targets, thereby individually assessing over 10 11 protein-protein interaction pairs, completed in two days. These selections yielded large, high-quality datasets and hundreds of novel binders, which we showed can be affinity matured or directly used in mammalian cells to inhibit or degrade targets. PANCS-Binders dramatically accelerates and simplifies the binder discovery process, the democratization of which will help unlock new creative potential in proteome-targeting with engineered binder-based biotechnologies.

Characteristics Associated with Engagement in the Early Detection Cascade of Care for Psychosis at a College Counseling Center.

Using the Cascade of Care framework, we explored the demographic and clinical characteristics of students at six stages in an early psychosis detection program at a college counseling center, with a focus on the transition between stages with the highest disengagement. We detailed and compared the demographic and clinical characteristics of those who (1) completed the Prodromal Questionnaire-Brief (PQ-B, N = 1588); (2) met the PQ-B cutoff score (n = 486); (3) were referred for secondary phone screening (n = 404); (4) completed secondary phone screening (n = 198); (5) completed a Coordinated Specialty Care (CSC) eligibility assessment (n = 51); and (6) were enrolled in CSC (n = 21). Education level and gender identity were associated with engagement at multiple stages of the early detection cascade. Graduate education level, transgender or gender diverse gender identity, alcohol use, and depressive symptoms predicted student follow-through with referral to secondary phone screenings.

Detection of Hepatitis C Virus Infection in Patients Undergoing Open Heart Surgery in Childhood Prior to 1992: A Danish Nationwide Cross-Sectional Study.

Pediatric patients undergoing cardiac surgery prior to 1992 in Denmark were at risk of hepatitis C virus (HCV) infection through donor blood used in extracorporeal circulation. HCV screening became possible in donors in 1991, eliminating the risk of iatrogenic infections. No formalized screening has been conducted for patients receiving non-screened blood, potentially leaving some with undetected HCV infection. This study aimed to determine the prevalence of chronic HCV infection in this group of patients and offer treatment to those affected. Nationwide cross-sectional study. Between 2020 and 2023, 1645 individuals who underwent pediatric heart surgery before 1992 in Denmark were identified. Participants were invited for HCV screening using anti-HCV-antibody and HCV-RNA tests. Patients testing positive for HCV were referred to direct-acting antiviral (DAA) treatment. Of 1645 patients identified, 571 consented to participate, and 246 completed HCV screening. Two individuals tested positive for chronic HCV infection, resulting in a prevalence of 0.8%. Both patients were asymptomatic for many years before treatment and successfully cleared the virus after DAA treatment. The 0.8% prevalence of HCV in this cohort is higher than in the general Danish population although lower than in similar studies from the U.S. and Germany. This may reflect Denmark's practice of unpaid blood donation, reducing infection risks. Targeted screening for at-risk cohorts exposed to transfusions before 1992 could aid in HCV detection and treatment, potentially preventing long-term liver complications. The study was approved by the Capital Region Ethics Board in Denmark (j.nr. H-18062088).

Implementation of a Hepatitis B Screening Program in Patients Receiving Systemic Anti-Cancer Therapy.

Cancer patients receiving non-endocrine therapies are at risk of hepatitis B virus (HBV) reactivation (HBVr). Guidelines recommend HBV screening prior to treatment. The Ottawa Hospital Cancer Center implemented a screening pilot for all patients receiving FOLFOX-based regimens between January and April 2023. We assessed the pilot from a quality improvement perspective. Charts were retrospectively reviewed, and patient and disease characteristics were collected. The primary endpoint was to identify the proportion of patients who underwent HBV screening prior to treatment start. Univariate analyses assessed the association between baseline characteristics and failure to screen. Quality metrics were also reviewed. There were 32/42 patients (76.2%) who completed screening, and 5 (11.9%) had a positive screen. The majority of eligible patients (59.5%) completed screening prior to the first treatment as intended. Four of five patients who tested positive were referred to Infectious Diseases. Of those, one received antivirals for chronic HBV. There were no treatment delays due to pending screening and no HBV reactivation. Receipt of prior systemic therapy was significantly associated with failure to screen (55 vs. 95%, OR 17.1 (95% CI 1.92-153), p = 0.011). The results of this pilot highlight the importance of building HBV screening into standardized treatment plans and engaging all team members to ensure high levels of screening. Prior systemic therapy receipt was associated with failure to screen, and thus, programs should include education on the necessity of screening as recommended by medical guidelines.

Association between sensitivity to thyroid hormone indices and type 2 diabetic microvascular complications in euthyroid patients

The correlation between thyroid hormone (TH) sensitivity and microvascular complications of type 2 diabetes mellitus (T2DM) remains uncertain. This study aimed to explore the association between TH sensitivity and the risk of diabetic kidney disease (DKD), diabetic retinopathy (DR), and diabetic neuropathy (DNP) in euthyroid T2DM patients. This study included a total of 946 hospitalized T2DM patients and calculated their sensitivity to the TH index, and each patient completed screenings for DKD, DR, and DNP. Multivariate logistic regression, generalized additive modeling, and subgroup analysis were used to assess the association between TH index sensitivity and the risks of DKD, DR, and DNP. After adjusting for confounding factors, a significant linear correlation was observed between the sensitivity of the thyroid feedback quartile index 3 (TFQI3) and DKD risk. However, the sensitivities of thyroid-stimulating hormone index (TSHI), thyrotropin thyroxine resistance index (TT4RI) and partial thyroid feedback quartile index (PTFQI) exhibited nonlinear correlations with the risk of developing DKD. The effect sizes to the left of the inflection point for TSHI, TT4RI and PTFQI were (odd ratio [OR] = 0.53, 95% confidence interval [CI]: 0.288–0.977), (OR = 0.863, 95%Cl: 0.751–0.992) and (OR = 0.007, 95%Cl: 0-0.724), respectively. However, there was no significant correlation between TH index sensitivity and DR/DNP risk. This study provides valuable insights into the relationship between TH sensitivity and the risks of DKD, DR, and DNP, with substantial clinical implications for individual prediction among T2DM patients.

Utilization and outcomes of serial cervical cancer screening in a National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in a non-Medicaid expansion state.

Since 1990, the Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has offered free cervical cancer screening to low-income, uninsured patients, increasing single time point screening and early detection rates. Little is known about NBCCEDP's longitudinal effectiveness. The objective of this study was to assess utilization of Kansas's NBCCEDP, early detection works (EDW) for one-time versus serial screening and compare rates of cervical dysplasia between groups. A retrospective cohort study was conducted among patients who received cervical cancer screening through EDW from 2001 to 2021. Demographic factors, Papanicolaou (Pap) test, and human papillomavirus (HPV) results were compared between patients with one screening versus multiple. Descriptive statistics were performed. From 2014 to 2021, 3.71-7.06% of eligible patients completed screening through EDW annually. 17.4% of 58,582 eligible patients were up-to-date with screening in 2020. Rural patients and those under age forty were less likely to have EDW screening. Of 43,916 ever-screened patients, 14,638 (33.3%) received multiple screenings. 77% of patients did not have HPV testing; rates were lower in serially screened patients. Cervical dysplasia rates differed minimally between groups. Despite screening 24,017 patients over 7years, EDW maintains up-to-date screening for under one-fourth of eligible Kansans. Young and rural patients less frequently access EDW. HPV testing is underutilized, which limits the negative predictive value of screening. Serial screening is largely used by low-risk patients currently. Identification and prioritization of serial screening in high risk could increase program impact.

Study on duration of symptoms of anal fissure and its impact on response to conservative treatment – A systemic review

Conservative treatment is the main course of action for anal fissure. The goal of this review was to see how symptom duration affected the anal fissure's responsiveness to conservative treatment.In this systematic review, We evaluated the duration of symptoms related to anal fissure as well as their effect on the response to conservative treatment. The study was done by referring journals and articles from PUBMED, Scopus, web of science and Elsevier for a systemic review and references for additional studies. All the articles and literature other than in English language are excluded. Atypical fissures which occur due to conditions like cancer, anal infection and inflammatory bowel disease are excluded. The key search words used are Anal fissure , Fissure in anal and conservative treatment, symptoms of anal fissure , Anal fissure and Glycery l Tri Nitrate (GTN), Anal fissure and Botox, Anal fissure and pathophysiology, Anal fissure and calcium channel Blockers, classification of anal fissure. A total yielded 1048 articles on initial search; first 614 duplicate publications were removed. After screening additional 467 articles were excluded and 147 full articles were assessed for the study. After performing complete screening data analysis of total 14 literature were involved in this present systematic review.This Systemic review can be concluded by the above mentioned finding that if symptom duration is less or in other words in acute anal fissures conservative treatment methods can work very effectively especially with GTN. However, as the duration of symptoms exceed the healing rate decreases attributing to the chronicity of the anal fissures. This renders the conservative treatment modalities less effective and making surgical treatment alternatives like Lateral internal sphincterotomy (LIS) the mainstay for chronic anal fissure.

Screening for Nonmedical Use and Misuse of Prescription Medication by Adolescents.

Several screening tools have been developed to identify youth with alcohol, cannabis, and tobacco/nicotine use disorders, although less attention has been paid to other substances, including the nonmedical use of prescription medication or prescription medication misuse. To evaluate the proportion of youth reporting the use of substances other than alcohol, cannabis, and nicotine on 3 screening tools that have been developed and validated for identifying alcohol, cannabis, and nicotine use disorders among adolescent primary care patients. Adolescents (N = 757) from primary care pediatric practices were randomized to complete substance use screening tools (Screening to Brief Intervention [S2BI, N = 242], Brief Screener for Alcohol, Tobacco, and Other Drugs [BSTAD, N = 253], Tobacco, Alcohol, Prescription Medication, and Other Substance Use [TAPS, N = 262]) and then complete a brief electronic assessment battery and a structured diagnostic interview that assessed for past-year use of opioids and benzodiazepines. A total of 716 adolescents with complete data for each screening tool and the structured interview were analyzed for this report. Rates of the nonmedical use of prescription medication or prescription medication misuse varied by tool: S2BI: 20 (8.5%), BSTAD: 4 (1.7%), and TAPS: 3 (1.3%). No participant endorsed benzodiazepine or opioid use on the World Mental Health Composite International Diagnostic Interview Substance Abuse Module. Rates of reporting the nonmedical use of prescription medication or prescription medication misuse vary by screen, and some exceed national estimates. Nonmedical use of prescription medication or prescription medication misuse may be more common than previously reported, although some responses may be false positives. Refining questions could elucidate an especially concerning behavior given widespread fentanyl contamination.

Synthesizing Carbon Nanodots for Longer Wave Quantum Emission in Biological Applications

Carbon quantum dots are activated carbon particles with a size of 1–10 nm that have unique properties such as stable temperature, high stability in the environment, and special chemical properties. Their emission spectrum is always wide and towards long wavelengths with a sharp decrease in intensity. In this work, carbon quantum dots with long emission wavelengths and productivity improvements for biological applications are investigated. In order to reduce the experiments and obtain the best method, the experiment is designed with a mini fever and screened between different factors. In addition, complete factorial screening is performed between three factors (time, OPDA, and ALCL3) and the results demonstrated that time factor and OPDA are more effective. Using a UV–vis fluorescence device, the samples were examined and with the software (Origin Probe), the diagrams of each sample are drawn and their quantum efficiency is recorded. Quantum efficiency is evaluated at 575 nm and 618 nm. Then, the TEM test examined the synthesized nanoparticles’ size. The average particle size synthesized in this project is reported to be about 3 nm. The effect of synthesized carbon quantum dots on fibroblast cells is investigated and the results demonstrated that the survival of these cells after 24 h of incubation with synthesized carbon dots could be more than 90%. As a result, these nanoparticles can be used in biological applications such as bioimaging as a diagnostic sensor for methylene blue. On the other hand, it was found that the nanoparticles synthesized in the presence of HCL have higher strength and wavelength.