Greater Frequency Research Articles

Familial Hypercholesterolemia: Genetics, Symptoms, Diagnosis and Treatment - A Literature Overview

Familial hypercholesterolemia is a genetic disorder of lipid management, especially LDL-C. It's inherited autosomal dominant in most cases. The illness is characterized by high, low-density lipoprotein cholesterol (LDL-C) levels. According to many researchers, the frequency of prevalence is estimated at 1:200 in the global population. Many studies showed that illness is underdiagnosed and therefore undertreated. There are three known genes coding three different proteins, and changes are in charge of wrong lipid management. These are: LDL-Receptor (LDLR), Apolipoprotein B (ApoB), and Proprotein convertase subtilisin/kexin 9 (PCSK9). People who are affected by mutation have around thirteen times higher risk of coronary artery disease (CAD) and, in order to that, premature death. Identifying sickness includes a physical examination, when we can observe xanthomas, corneal arcus, or xanthomata, and scales that focus on the patient's as well as his family's past. A definite diagnosis can be approved by genetic testing, which shows a causable mutation. The main goal in treatment therapy of familial hypercholesterolemia is to reduce the concentration of LDL-C in serum. First of all, patients should know what to do to reduce LDL-C levels. Education is critical for understanding the problem and creating a successful course. Moreover, it is necessary to quit smoking, increase physical activity, and reduce cholesterol, elevating products from diet such as saturated fats and alcohol. Weight reduction is recommended. In addition, pharmacological treatment must be performed. All individuals have statins implemented. In most cases, one drug isn't enough, so therapy containing ezetimib is common. Novel treatments, including monoclonal antibodies (mAb), antisense oligonucleotides (ASO), and PCSK9- inhibitors nowadays, are used with greater frequency and better results, providing higher efficiency in achieving targets.

Immunogenetics of longevity and its association with human endogenous retrovirus K

IntroductionThe human immune system is equipped to neutralize and eliminate viruses and other foreign antigens via binding of human leukocyte antigen (HLA) molecules with foreign antigen epitopes and presenting them to T cells. HLA is highly polymorphic, resulting in subtle differences in the binding groove that influence foreign antigen binding and elimination. Here we tested the hypothesis that certain HLA alleles may promote longevity by enhanced ability to counter virus antigens that may otherwise contribute to morbidity and mortality.MethodsWe utilized high-resolution genotyping to characterize HLA and apolipoprotein E in a large sample (N = 986) of participants (469 men, 517 women) ranging in age from 24 to 90+ years old (mean age: 58.10 years) and identified 244 HLA alleles that occurred in the sample. Since each individual carries 12 classical HLA alleles (6 alleles of each Class I and Class II), we determined in silico the median predicted binding affinity for each individual (across the 12 HLA alleles) and each of 13 common viruses (Human Herpes Virus 1 [HHV1], HHV2, HHV3, HHV4, HHV5, HHV6A, HHV6B, HHV7, HHV8, human papilloma virus [HPV], human polyoma virus [JCV], human endogenous retrovirus K [HERVK], and HERVW). Next, we performed a stepwise multiple linear regression where the age of the participant was the dependent variable and the 13 median predicted HLA-virus binding affinities were the independent variables.ResultsThe analyses yielded only one statistically significant effect–namely, a positive association between age and HERVK (P = 0.005). Furthermore, we identified 13 HLA alleles (9 HLA-I and 4 HLA-II) that occurred at greater frequency in very old individuals (age ≥90 years) as compared to younger individuals. Remarkably, for those 13 alleles, the predicted binding affinities were significantly higher for HERVK than for the other viruses (P < 0.001). ApoE genotypes did not differ significantly between older and younger groups.DiscussionTaken together, the results showed that HLA-HERVK binding affinity is a robust predictor of longevity and that HLA alleles that bind with high affinity to HERVK were enriched in very old individuals. The findings of the present study highlight the influence of interactions between host immunogenetics and virus exposure on longevity and suggest that specific HLA alleles may promote longevity via enhanced immune response to specific common viruses, notably HERVK.

With Proper Surgical Indications, Sex-Based Differences in Pathology Do Not Impact Hip Arthroscopy Outcomes or Complications: A Systematic Review.

To identify sex-based differences in pathology, outcomes, and complications after hip arthroscopy for femoroacetabular impingement (FAI), and to compare patient-reported outcomes (PRO) scores between male and female patients. The PubMed and MEDLINE databases were searched in September 2024, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies had data stratified by sex, minimum 2-year PRO scores for hip arthroscopy in the setting of FAI and labral pathology, and a 2014 or later publication date. Patient demographic information, preoperative radiographic measurements, and surgical procedure information was also recorded. PROs were recorded when discussed. Information on the minimum clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit was recorded when available. In total, 21 studies were included in the systematic review. The systematic review found that there are sex-based differences in preoperative characteristics, such as male patients having a significantly greater incidence of acetabular injury, larger alpha angle, complex labral tearing, and greater grade LT villar classification, leading to differences in surgical indication, and female patients being indicated for capsular repair or plication at a greater frequency. There was a significant heterogeneity between male and female patients for preoperative modified Harris Hip Score (mHHS) (male: 55.7-83; female: 49-64.45; I2= 0.78), Non-Arthritic Hip Score (NAHS) (male: 62.54-78.1; female: 47.2-66; I2= 0.77), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) (male: 46.72-52.3; female: 22.8-45.7; I2= 0.96), as well as postoperative HOS-SSS (male: 72.2-91; female: 62.6-82.4; I2= 0.66). Despite these differences, both male and female patients experienced similar magnitudes of improvement for mHHS (male: 13-20.14; female: 20.6-30.2; I2= 0.00), NAHS (male: 18-19.93; female: 18.75-33.5; I2= 0.00), and HOS-SSS (male: 27.7-31.4; female: 26.75-39.8; I2= 0.42), as well as postoperative scores for mHHS (male: 82.445-96; female: 79.2-89.6; I2= 0.00) and NAHS (male: 82.445-94.5; female: 81.2-89.2; I2= 0.00). No differences were consistently identified in regard to survival rates and complications. Male and female patients present with different preoperative characteristics that affect surgical treatment. With proper surgical indication, both male and female patients achieve significant postoperative improvement after hip arthroscopy and demonstrate comparable survival rates. Level IV, systematic review of Level II-IV studies.

Patient-Nurse Communication in an Oncology Hospital Setting: A Qualitative Study.

Communication is an important aspect in making patients competent to define, process, and manage their disease condition as well as to intercept and satisfy psychosocial needs. Communication between patient and nurse is central to the learning and orientating process since the nurse has the greatest frequency and continuity of relationship with patients and their families. This study aims to investigate the quality of communication between patient and nurse and the factors that promote or hinder effective communication from the oncology patient's perspective within an inpatient hospital setting. A descriptive qualitative study was conducted with one-to-one semi-structured interviews analyzed using the Framework Analysis methodology. The population consisted of oncologic patients admitted to the Medical Oncology Units of the Regina Elena National Cancer Institute in Rome. Data were analyzed using Ritchie and Spencer's Framework Analysis. The sample comprised 20 patients, with an average age of 61.35, admitted to the Medical Oncology Units of the Regina Elena National Cancer Institute in Rome. Three themes emerged: positive communication as an element of care, factors fostering communication, and factors hindering communication. The sample interviewed deems the quality of communication satisfactory. Familiar communication style, direct language, and caring are factors fostering communication. In contrast, lack of communication between medical and nursing staff, shortage of staff, and lack of time are considered communication barriers. Advanced communication competencies in nurses are crucial for effectively addressing the emotional and psychosocial needs of cancer patients, fostering a more empathetic and supportive care environment.

A review study on Guillain barre syndrome

Acute immune-mediated peripheral nerve system dysfunction known as Guillain-Barre Syndrome (GBS) is typified by rapidly worsening muscle weakness, which frequently begins in the lower limbs and can eventually result in paralysis. It is typically brought on by an infectious event, most often a bacterial or viral infection, with Campylobacter jejuni being the most often linked harmful organism. According to epidemiology, there are 1-2 instances of GBS for every 100,000 people each year, with a small male predominance and greater frequency in adults over 50. Nerve conduction investigations and cerebrospinal fluid analysis demonstrating albumin cytological separation complement the largely clinical diagnosis.

ПОЛИМОРФИЗМ ГЕНА ПРОЛАКТИНА В ПОПУЛЯЦИИ МОЛОЧНОГО СКОТА ОМСКОЙ ОБЛАСТИ

The purpose of the study is to determine the polymorphism of the prolactin gene in the dairy cattle population of the Omsk Region. Objectives – to carry out genetic monitoring of the cow population for the presence of the desired allele of the PRL gene in the genotype;to determine the frequency of genotypes and alleles of the PRL gene in the studied population. The object of the study is a population of dairy cattle of the red steppe breed, bred at 2 enterprises – a breeding reproducer and a leading commodity farm in the Omsk Region. In cattle bred at the enterprises of the Omsk Region, with the greatest frequency there were animals that were not carriers of the PRL gene leading to/associated with the studied phenotype. In the enterprises of the Omsk Region, with the highest frequency, there were animals that were not carriers of the PRL gene leading to/associated with the studied phenotype, which had values in the range from 0.74 to 0.8. Analysis of the frequency distribution of heterozygous genotypes for the studied PRL gene was only from 0.40 to 0.52. The frequency of occurrence of genotypes with the desired allele A among animals bred in a commercial farm turned out to be higher by 0.12 compared to the frequency of occurrence in a breeding reproducer. In the studied animals of the red steppe breed, bred at the enterprises, there was no homozygous genotype for the A-allele. In a breeding reproducer, with the age of animals, the frequency of carriers of the desired allele increases. 58 % of first-calf heifers are carriers of the A allele of the PRL gene. The maximum frequency of occurrence of genotypes with the associated allele A of the PRL gene in the group of cows of the 3rd lactation is 90 %, and only 10 % of cows in this group have the BB genotype. The revealed frequency of genotypes in the context of lactations makes it possible to judge the organization of selection and breeding work in herds. To increase in the population of animals with the A/A and A/B genotypes, it is necessary to select and assign sires with the A/A genotype for the PRL gene to the cows of this population.

Bidirectional links between sleep and pain among heavy-drinking Veterans with insomnia

Abstract Study Objectives Military veterans often suffer from chronic pain and sleep issues at a greater frequency than the general population, leading some to self-medicate with alcohol. While research shows a connection between sleep and pain, few studies have examined bidirectional links between sleep and pain at the daily level–or the extent to which alcohol use may moderate these associations. Methods Heavy-drinking veterans seeking treatment for insomnia (N=109, 82.5% male, mean age 38.9y) completed 14 days of morning diaries documenting sleep patterns, pain intensity, and alcohol consumption. Multilevel modeling examined within- and between-person associations between sleep (quality, duration, and efficiency) and next-day pain as well as pain and same-night sleep. Results Individuals with longer sleep duration, better sleep quality, and higher sleep efficiency reported lower pain levels compared to those with shorter sleep, poorer sleep quality, and lower sleep efficiency (p-values <.001 to .01). Additionally, on days when individuals experienced better sleep quality compared to their own average, they reported lower pain levels the following day (p=.01). In contrast to hypotheses, daily pain levels did not predict sleep outcomes at the daily within-person level, although significant between-person correlations were noted. Daily alcohol intake did not affect these relationships. Conclusions Sleep quality is associated with the daily experience of pain among heavy-drinking veterans with insomnia. Daily variations in sleep quality significantly impact pain, irrespective of alcohol consumption, highlighting a predominantly unidirectional influence from sleep to pain. These findings underscore the importance of optimizing sleep to mitigate pain in this population.

Contrasting characteristics of psychosis in outpatients with borderline personality disorder or schizophrenia at a tertiary care institution.

Borderline personality disorder (BPD) and schizophrenia can present with psychotic symptoms, such as delusions and hallucinations. This study, conducted at a tertiary care center, compared the characteristics of psychotic symptoms in patients diagnosed with BPD and patients diagnosed with schizophrenia, as well as the prevalence of self-harm, suicide attempts, and hospitalizations within these groups. In this comparative study, 50 individuals diagnosed with BPD and 50 with Schizophrenia, aged between 18 and 45 years, were assessed for intensity of psychotic symptoms with the Psychotic Symptom Assessment Scale (PSYRATS) and the Cardiff Abnormal Perceptions Scale (CAPS). Data were analyzed with IBM SPSS v25.0. On the PSYRATS, the schizophrenia group scored higher in auditory hallucinations and in the number of voices, while in the BPD group the auditory hallucinations score was correlated with the number of suicide attempts (P=0.025). On the CAPS, the BPD group showed higher scores on positive abnormal perceptions in all dimensions compared to the schizophrenia group (P=0.002). Our study suggests that patients with BPD experienced a more intense burden of psychotic-like experiences compared to those with Schizophrenia, with a greater frequency, interference, and distress reported. Although patients with Schizophrenia had higher scores on the PSYRATS, the BPD group's scores were also notable, and a correlation was identified between auditory hallucinations and suicide attempts in the BPD group.

Rise of the Machines - Normothermic Regional Perfusion Use in Heart Transplantation in the United States.

Recently, normothermic regional perfusion (NRP) and direct procurement and perfusion (DPP) have allowed for heart transplantation following donation after circulatory death (DCD). This study aimed to characterize utilization and variation of NRP and DPP in the United States. Heart transplants from 12/1/19-3/31/24 were identified from the United Network for Organ Sharing Database. DPP and NRP procurements were classified based on previously published methods. The groups were compared, and survival was assessed using Kaplan-Meier methods. Geographic and center variability was categorized using encrypted data. There were 595 NRP transplants and 625 DPP transplants. Distance traveled and out of body time were significantly less for the NRP group (p<0.01 for both). There were no significant differences in post-operative dialysis, stroke or 1-year survival between groups, however post-operative pacemaker placement was higher with NRP (p<0.05). From 2019 to 2024, 54/61 centers (88.5%) used NRP, 50/61 centers (82%) used DPP, and 43/61 centers (70.5%) used both procurement techniques, with NRP currently being the most popular DCD procurement technique. Geographically, recipients from regions 2, 5 and 8 used NRP with greatest frequency, while those in regions 1, 3 and 10 used DPP with greatest frequency. NRP use is rising within the United States, with tremendous growth since its inception a few years ago. Significant variation still exists regarding utilization of NRP and DPP and further determination of the impact of each procurement and preservation strategy on transplantation outcomes is necessary.

Parámetros del reforzador en la resistencia a la extinción en humanos

Resistance to extinction refers to the persistence of an operant after discontinuing the reinforcement associated with it. The Behavioral Momentum Theory indicates that an operant is more resistant to change when associated with a component with a greater frequency or magnitude of reinforcement. This has been consistently shown in non-human organisms. However, there are inconsistencies in the results obtained with humans that could be explained methodologically by the type of tasks and the type of reinforcements used in the experiments. The aim of this study was to analyze the effects of varying the frequency and magnitude of reinforcement under a resistance-to-extinction paradigm. Eighteen university students between 18 and 26 years old participated, distributed in three experiments. Results indicated that using a novel experimental task with precise instructions favors individual-level consistency with humans. However, it is important to verify the type of analysis been chosen.

Variabilidad, tendencia y eventos extremos en los rendimientos agrícolas a nivel de partidos en la provincia de Buenos Aires

Climate variability is the main determinant of fluctuations in the productive and economic results of agriculture. Extreme events are expected to occur with greater frequency and intensity in the future. In this scenario, the effects of climate variability on agricultural production are of special interest. This study analyzes the time series of yields at the county level of the main crops in the province of Buenos Aires, in the period 2000/01-2020/21. The trend and occurrence of extreme values ””of wheat, corn and soybean yields are identified. The frequencies of extreme values ””are related to the phases of the ENSO -El Niño-Southern Oscillation phenomenon, for each crop year. Yields show significant positive trends in 78%, 46% and 30% of the counties for wheat, corn and soybean, respectively. There is a significant relationship between the frequencies of extreme yield values ””and the ENSO phases, this relationship being more important in summer crops. In particular, there is a relative frequency of extremely low or very low yields of 38 and 41%, in second consecutive La Niña crop years, for corn and soybean, respectively. While the frequencies of extremely low or very low yields in neutral or El Niño crop years are between 0% - 3%. Regarding the economic value of production, the differences between obtained vs. expected values, accumulated in the period, are positive values of +3285 and +872 million USD in “El Niño” years for the north and south regions, respectively, and negative values of -3387 and -388 million USD, in “La Niña” years for both regions, respectively. The results provide evidence on the potential value of ENSO-based seasonal forecasts for agriculture. However, it is necessary to deepen the analysis of the effects of ENSO and other seasonal phenomena on yields. It is also necessary more information about the attitudes of the farmers in the Pampas and the different management practices that can be adjusted based on these forecasts.

Analysis of Scattering Mechanisms in SAR Image Simulations of Japanese Wooden Buildings Damaged by Earthquake

The difficulty in identifying collapsed houses and damaged structures in synthetic aperture radar (SAR) images after natural disasters represents a significant challenge in the monitoring of urban structural deformation using SAR. SAR image simulation was conducted on a three-dimensional model of a typical wooden building in Japan to analyze the scattering mechanism of the structure in collapsed and uncollapsed states. Based on the physical properties of the buildings, a correlation was established between the simulated SAR image feature signals and the geometric structures of the buildings. The findings indicate that SAR scattering is more uniform for uncollapsed structures, which is predominantly influenced by their geometry. At low incidence angles, single reflections were the predominant phenomenon, whereas at high incidence angles, multiple reflections became more prevalent. The uncollapsed building’s facade formed a dihedral angle, exhibiting bright lines in the SAR image. Multiple reflections occurred at the edges of the building and floor junctions. These findings follow the theoretical predictions. In the case of the collapsed buildings, multiple reflections occurred with greater frequency, and irregular scattering was observed. Notwithstanding the augmented scattering pathways, some walls nevertheless manifested single reflections. The collapsed structures demonstrated a reduced sensitivity to alterations in the angle of incidence.

Frequency and voltage dependent of electrical and dielectric properties of Ag/GO doped NiO/p-Si/Al MOS structures under darkness and light

At studying, we searched the frequency and voltage dependency of the electrical and dielectric traits of a nano-made NiO-contributed GO thin film enlarged on a p-type silicon substrate using sol-gel technique. The electrical and dielectric features of Ag/GO-NiO/p-Si were investigated by capacitance–voltage (C–V) and conductance–voltage (G/ ω–V) indications in the frequency interval of 10 kHz–1000 kHz below dark and illumination at ambient temperature. While the capacitance and series resistance (Rs) values decrease with increment of frequency and increment trend in conductance was observed with the increasement of frequency. These decrement/increment trend observed at greater frequencies are attributed to existence of interface state densities. After, the frequency dependence of dielectric constant (εʼ), dielectric loss (εʼʼ), loss tangent (tanδ), ac electrical conductivity (σac) and complex impedance (Z∗) of Ag/GO-NiO/p-Si structures were investigated in the frequency by means of the capacitance–voltage (C–V) and conductance-voltage (G/w-V) indications. The experimental findings showed that εʼ, εʼʼ and σac were strongly frequency dependent.

Evaluation of Smell Function in Patients with Childhood Epilepsy with Centrotemporal Spikes at a Pediatric Neurology Clinic-A Case-Control Study.

Objective: Childhood epilepsy with centrotemporal spikes (CECTS) is associated with cognitive, behavioral, and language difficulties. These epileptic discharges predominantly occur in the temporal lobe, which is known to be involved in olfactory functions. This study aims to assess olfactory dysfunction in patients with CECTS. Methods: This study included patients diagnosed with CECTS who were attending follow-ups at the Department of Child Neurology between January 2022 and July 2023. Olfactory function was evaluated using the Sniffin' Sticks (Burghart GmbH, Wedel, Germany) 12-point screening test, which was administered to 44 patients and 35 controls. The smell test and the final control EEGs were performed simultaneously. Results: A total of 44 patients and 35 control subjects were enrolled in this study. The smell scores were significantly lower in the patient group compared to the control group (p = 0.029). The patient group had a very high prevalence of anosmia compared to the control group. The normosmia rate in the control group was significantly higher. No significant difference was observed in the smell scores based on EEG findings or antiepileptic drug type. Conclusions: Olfactory dysfunction was identified in patients with CECTS compared to healthy controls, yielding results consistent with findings for other types of epilepsy. Olfactory dysfunction was detected in a greater frequency among the patients diagnosed with CECTS than among the healthy control group, and similar results were obtained with other types of epilepsy. It was deduced that these patients may experience problems with smell sensitivity throughout their lives. The most important result of this study is that this condition should be taken into account in regard to patients' well-being and lives.

The role of pollen and NPP research in palaeoenvironmental reconstruction of the Neolithic archaeological site “Gorjani-Topole” (Slavonia region, eastern Croatia)

The palynological study of eight samples from the Gorjani-Topole archaeological site was conducted with the aim of palaeoenvironmental reconstruction. In total, 44 different palynomorphs were recorded: 12 pollen taxa, 23 fungal spores/remains, four algal cysts, one amoebae and four palynomorphs of unknown origin. Among the non-pollen palynomorphs, Chomotriletes (previously Pseudoschizaea) occurred with the greatest frequency and abundance. The low pollen richness accompanied by the presence of only a few sporopolleninrich pollen types indicates unfavourable preservation conditions in the analysed core samples. The dominance of erosion/desiccation indicators supports the scenario of significant oscillations of the hydrological level in the sediments, with periodic drying of the substrate. Although the interpretation of changes in plant cover, due to the reduced pollen spectrum, is not feasible, it is still possible to indicate paleoecological trends and partially interpret them, considering the indicator value of the few preserved palynomorphs. The findings of cultivated grass pollen (Cerealia) and other anthropogenic indicators including weed pollen (Convolvulus arvensis) are of great importance. Moreover, Riccia moss spores or fungal Epicoccum spores could also indicate the anthropogenic impact on the study area.

Sex differences in reporting of statin-associated diabetes mellitus to the US Food and Drug Administration

Abstract Background Statins have been reported to precipitate diabetes mellitus (DM) in some patients. Limited evidence suggests that this occurs in women more frequently than men, but direct comparisons of rates of reporting of statin-associated DM between men and women are lacking. Purpose To determine whether there are sex-specific differences in post-marketing reporting of statin-associated DM. Methods We conducted a retrospective pharmacovigilance analysis of spontaneously reported adverse drug events (ADEs) submitted to the Food and Drug Administration (FDA) Adverse Event Reporting System between January 1997 and September 2023. A Proportional Reporting Ratio (PRR) was used to identify the rate of reported statin-associated DM ADEs relative to the rate of DM ADEs reported with all other medications. We compared signals of disproportionate reporting (SDRs) between men and women using a modified relative odds ratio (ROR). Results During the study period, there were two-fold as many reports of statin-associated DM in women than in men (14,793 versus 7,307, respectively), despite the fact there were only 7% more non-DM statin ADEs reported in women compared to men (512,134 versus 480,849, respectively). Compared to the background rate of reporting for all ADEs (0.6%), statin-induced DM was disproportionally reported for all subjects in aggregate (2.1%, PRR=3.7) as well as for men only (1.5%, PRR=2.4) and for women only (2.9%, PRR=5.3). Significant PRRs for DM were observed with each statin and for all statins collectively (Figure 1). Statins were reported as the primary- or secondary-suspected cause of DM in women with considerably greater frequency than in men (58% versus 29%, respectively). Rates of reporting of statin-associated DM were higher in women than in men for all statins, with the greatest difference being observed with atorvastatin (ROR 3.0), and the lowest difference being observed with rosuvastatin (ROR 1.2) (Figure 1). Conclusions Post-marketing ADE surveillance data suggest a markedly higher rate of incident DM associated with statins than with other medications and a higher rate of reporting of statin-associated DM in women than in men. Future studies should consider sex-moderated mechanisms of statin-associated DM.Figure 1

Services for perinatal patients with opioid use disorder: a comprehensive Baltimore City-wide 2023 assessment

BackgroundOverdose is a leading cause of maternal mortality; in response, maternal mortality review committees have recommended expanding substance use disorder (SUD) screening, improving collaboration between obstetric and SUD treatment providers, and reducing fragmentation in systems of care. We undertook an analysis of the perinatal SUD treatment landscape in Baltimore, Maryland in order to identify barriers to treatment engagement during pregnancy and the postpartum period and guide system improvement efforts.MethodsWe conducted a survey of seven birthing hospitals, 31 prenatal care practices, and 108 SUD treatment providers in Baltimore from April-June 2023. Organizations were asked to quantify care for perinatal patients with opioid use disorder (OUD) as well as about screening, service availability, referral practices, and support needed to improve care.Results61% of the 145 contacted organizations responded. Birthing hospitals reported caring for pregnant persons with OUD with greater frequency than prenatal care practices or SUD treatment programs. Most birthing hospitals and prenatal care practices reported screening for OUD at intake, but the minority reported using validated tools. Service availability varied by type of organization and type of service. In general, prenatal care practices offered the fewest number of SUD-related services. Most SUD treatment programs that offered buprenorphine or methadone to the general population also offered these medications to pregnant patients. Withdrawal management for comorbid alcohol/benzodiazepine use disorders during pregnancy was more limited. The majority of birthing hospitals and prenatal care practices reported offering neither direct naloxone distribution nor prescriptions. Few SUD treatment programs offered tailored services for perinatal patients or for parents of young children, and many programs do not permit children onsite. Respondents reported high levels of interest in education and consultative support on SUD treatment in pregnancy within obstetric settings and on pregnancy-related medical concerns within SUD programs.ConclusionsThis project provides a comprehensive picture of services available for treatment of perinatal OUD in a major US city. Results have served as a guide for ongoing citywide system improvement efforts by our project team and offer a model for other jurisdictions hoping to strengthen services for perinatal OUD and reduce maternal mortality.

The Relationship Between Nurses' Digital Health Literacy and Their Educational Levels, Professional Roles, and Digital Attitudes: A Cluster Analysis Based on a Cross-Sectional Study.

The current study aimed to identify digital health literacy levels among nurses with respect to their education, role and attitude towards digital technologies. Cross-sectional study. Through convenience sampling, all Registered Nurses, managers/leaders and nurse researchers employed in Hospitals, University Hospitals and Districts were recruited and surveyed using an online questionnaire. The data collection tool assessed: (I) demographics, (II) Digital Health Literacy (DHL) with the Health Literacy Survey19 Digital (HLS19-DIGI) instrument including DHL dealing with digital health information (HL-DIGI), interaction with digital resources for health (HL-DIGI-INT) and use of digital devices for health (HL-DIGI-DD); (III) attitudes on the use of digital technologies in clinical practice. The multiple correspondence analysis was applied to identify three clusters for the education/professional role (A, B, C) and three for digital technologies' use (1, 2, 3). The one-way nonparametric analysis of variance (Kruskal-Wallis test) was applied to compare HL-DIGI, HL-DIGI-INT and the HL-DIGI-DD scores among clusters. Among 551 participants, the median scores of the HL-DIGI, the HL-DIGI-INT and the HL-DIGI-DD questionnaires were 70.2, 72 and 2.00, respectively. The distribution in the clusters 'educational/professional role' was A, (58.8%); B, (16.5%); and C, (24.7%). Nurses in a managerial or coordinator role and with a postgraduate degree used digital resources with greater frequency. The distribution in the clusters 'use of digital technologies' was: 1, (54.6%); 2, (12.2%); and 3, (33.2%). The HL-DIGI-DD and HL-DIGI scores of clusters 1, 2 and 3 differed significantly. DHL among nurses is strongly influenced by the education level, professional role, habits and attitude towards digital technologies. Nurses with coordinator roles used digital technologies with greater frequency and had a higher level of DHL. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were used for reporting. No Patient or Public Contribution. Local Ethical Committee of the Polyclinic of Bari (code: DHL7454, date: 21/09/22).

The Incidence of Shoulder and Elbow Injuries in High School and Collegiate Softball Athletes: A Systematic Review.

Despite increased youth and adolescent participation in fast-pitch softball and the reporting of upper extremity injuries, there remains a relative paucity of research examining shoulder and elbow injuries in high school and collegiate softball athletes. To evaluate the reported incidence, setting, and positional factors associated with shoulder and elbow injuries in high school and collegiate fast-pitch softball players. PubMed, Ovid, Medline, EMBASE, Scopus, Cochrane Central, and Clinicaltrials.gov. English-language articles reporting the incidence of shoulder and/or elbow injuries occurring in high school or collegiate fast-pitch softball players were included. Biomechanical studies, review articles, abstract only texts, previous systematic reviews, and meta-analyses were excluded. Systematic review. Level 4. Two reviewers independently evaluated studies. Data related to the reported incidence of shoulder and elbow injuries, injury setting, position, and rate of return to play after injury were recorded. A total of 22 studies were identified. In high school athletes, shoulder injury rates ranged from 0.88 to 1.14 per 10,000 athletic exposures (AE), with elbow injury rates ranging from 0.41 to 0.71 per 10,000 AE. In collegiate athletes, reported injury rates ranged from 3.76 to 5.93 per 10,000 AE for shoulder and 1.5 to 3.39 per 10,000 AE for elbow injuries. Shoulder and elbow injuries were reported more commonly during competition in high school athletes, and with greater frequency in the practice setting in collegiate athletes. No association between injury incidence and position was appreciated at either the high school or collegiate level. Most (81%-96%) athletes were able to return to sport within 3 weeks of injury. The incidence of shoulder and elbow injuries was greater in collegiate softball athletes than in high school athletes.

Salesperson intra-career mobility perceptions: Exploring the role of professional versus organizational identities

Salesperson career paths have evolved from traditional to boundaryless models, as salespeople are moving between sales organizations with greater frequency. In this new landscape, it is crucial to consider how salespeople’s perceptions of their employers and the sales profession impact their mobility. While previous research has focused on salesperson identification with their organization, identification with the profession remains largely unexplored. To address this gap, the authors conducted semi-structured interviews with 57 sales professionals to better understand their work identities. They offer a theoretical model illustrating how professional and organizational identities become more or less salient, influencing intra-career mobility (i.e., job movement within the sales profession). When salespeople experienced a mismatch between their work realities and desired identities, they redefined their sales roles around a core work value. This process shifted their focus towards their professional identity over their organizational identity, affecting their perceptions of mobility within the sales profession.