United States Research Articles

A Systematic Review and Meta-Analysis Assessing Diversity and Representation in Diabetic Retinopathy Clinical Trials in the U.S.

ABSTRACT Purpose To perform a systematic review and meta-analysis assessing the diversity and representation of diabetic retinopathy (DR) patients in clinical trials conducted in the United States from January 1, 2018, to December 31, 2023. Methods A comprehensive search strategy was conducted on May 28th, 2024 using MEDLINE (PubMed) and Embase (Elsevier) to identify relevant clinical trials. Inclusion criteria included trials published between January 1, 2018 and December 31, 2023, focusing on interventions for DR that were conducted in the United States. Screening and data extraction were independently performed by three reviewers. Results Eleven clinical trials met the inclusion criteria and were analyzed for participant representation based on sex, age, and race/ethnicity. Sex representation was rated as good in 9 of the 11 studies. However, age representation was rarely reported (only 1/11 studies) and race/ethnicity representation was poor in 6 of the 11 studies. The findings highlight significant underrepresentation of Asian and Black populations. Conclusion This study reveals substantial disparities in the demographic representation within DR clinical trials in the United States, emphasizing the critical need for improved inclusion strategies. Enhancing diversity in these trials is essential for producing research findings that are more applicable to the broader population affected by DR, ultimately contributing to more equitable healthcare outcomes and advancing the effectiveness of treatments across diverse demographic groups.

Culture and attachment preference among young adults in Egypt and the United States

ABSTRACT We explored the relationship between cultural values, recollected early caregiving experiences and young adult attachment preference. Young adults in Egypt (N = 209) and the United States (N = 554) ranked their current attachment preference, rated their collectivist and individualist beliefs, and recalled the relative contributions of their early caregivers. Egyptian students scored higher than US students on collectivism and recalled more involvement from non-parental caregivers. Most participants reported a preference hierarchy (82% Egypt & 84% US). Surprisingly, individualism was negatively associated with maternal attachment ratings and with having a clear principal attachment relationship, whereas higher collectivism predicted higher maternal attachment. Findings suggest that attachment hierarchies are normative across varying cultural and child-rearing contexts.

Depression, anxiety, and stress among USMLE aspirants: a cross-sectional survey

Background: The United States Medical Licensure Examination (USMLE) represents a critical step for medical licensure in the United States, requiring extensive preparation that can lead to significant mental health challenges among aspirants. This study aims to explore the prevalence and contributing factors of depression, anxiety, and stress among USMLE aspirants. Methods: This cross-sectional survey investigates the prevalence and contributing factors of depression, anxiety, and stress among USMLE aspirants. We deployed a detailed online and paper-based questionnaire targeting a diverse pool of 321 medical students and graduates globally. The survey incorporated validated scales such as the Perceived Stress Scale, Generalized Anxiety Disorder 7-item scale, and Patient Health Questionnaire-9 to evaluate mental health statuses. Data analysis was conducted using SPSS, focusing on demographic correlations and mental health outcomes. Results: A total of 321 participant’s data were collected, out of whom 51.1% (n = 164) were male and 48.9% (n = 157) were female. 91.3% (n = 293) were International Medical Graduates (IMG), while 8.7% (n = 28) were American Medical Graduates (AMG), educational status results show undergraduates 38.6% (n = 124) and graduates 61.4% (n = 197). Participants were interviewed through a validated questionnaire, and 75.1% (n = 241) had depression, 71.96 (n = 231) had anxiety, (n = 16) had low stress, (n = 231) had moderate, and (n = 66) had severe perceived stress. Conclusion: Our study reveals a high prevalence of depression, anxiety, and stress among USMLE aspirants, with significant variations across demographic subgroups and chosen medical specialities.

A grounded theory study on how Chinese international graduates of mental health programs in the United States of America adapt to professional practice in China

ABSTRACT Objective Many Chinese international graduates, having completed graduate-level programs that teach students to provide mental health services to clients (e.g. counselling, psychology, social work) in the United States of America, return to China for professional practice. However, their adaptation process often brings unexpected challenges. This study aimed to develop a process model of how Chinese international graduates from mental health programs adapted to professional practice upon their return to China. Method Using grounded theory, the researchers collected data by interviewing 12 participants who studied in mental health programs in the United States of America and returned to China for professional practice. Results A process model described how returning Chinese international graduates adapted to professional practice in China was developed. The model included the themes of chaos, transition, integration, emotional reactions, and coping strategies. Discussion The Chinese international graduates went through a process of chaos, transition, and integration. They used numerous coping strategies to facilitate the adjustment process. During the process, they experienced various emotions, including both pleasant and unpleasant feelings. The study findings offer valuable insights for returning Chinese international graduates, mental health programs in the United States of America, and the counselling profession in China.

Machine learning-based myocardial infarction bibliometric analysis

PurposeThis study analyzed the research trends in machine learning (ML) pertaining to myocardial infarction (MI) from 2008 to 2024, aiming to identify emerging trends and hotspots in the field, providing insights into the future directions of research and development in ML for MI. Additionally, it compared the contributions of various countries, authors, and agencies to the field of ML research focused on MI.MethodA total of 1,036 publications were collected from the Web of Science Core Collection database. CiteSpace 6.3.R1, Bibliometrix, and VOSviewer were utilized to analyze bibliometric characteristics, determining the number of publications, countries, institutions, authors, keywords, and cited authors, documents, and journals in popular scientific fields. CiteSpace was used for temporal trend analysis, Bibliometrix for quantitative country and institutional analysis, and VOSviewer for visualization of collaboration networks.ResultsSince the emergence of research literature on medical imaging and machine learning (ML) in 2008, interest in this field has grown rapidly, particularly since the pivotal moment in 2016. The ML and MI domains, represented by China and the United States, have experienced swift development in research after 2015, albeit with the United States significantly outperforming China in research quality (as evidenced by the higher impact factors of journals and citation counts of publications from the United States). Institutional collaborations have formed, notably between Harvard Medical School in the United States and Capital Medical University in China, highlighting the need for enhanced cooperation among domestic and international institutions. In the realm of MI and ML research, cooperative teams led by figures such as Dey, Damini, and Berman, Daniel S. in the United States have emerged, indicating that Chinese scholars should strengthen their collaborations and focus on both qualitative and quantitative development. The overall direction of MI and ML research trends toward Medicine, Medical Sciences, Molecular Biology, and Genetics. In particular, publications in “Circulation” and “Computers in Biology and Medicine” from the United States hold prominent positions in this study.ConclusionThis paper presents a comprehensive exploration of the research hotspots, trends, and future directions in the field of MI and ML over the past two decades. The analysis reveals that deep learning is an emerging research direction in MI, with neural networks playing a crucial role in early diagnosis, risk assessment, and rehabilitation therapy.

Examining Geographic Disparity: Variation in Cancer Outcomes within Appalachia.

The Appalachian region of the United States (US) extends from the Mississippi delta to southern New York. Although disparities in Appalachian cancer outcomes have long been observed, recent rates and trends have not been assessed. We calculated 5-year age-adjusted US cancer incidence and mortality rates for 2017-2021, stratified into Appalachian and non-Appalachian populations, as well as Appalachian subregions, using the US Cancer Statistics Incidence Analytics Database and National Center for Health Statistics mortality files. Annual rates for 2004-2021 were also calculated. In 2017-2021, all-site cancer incidence (466.6; 95% confidence interval (CI), 465.5-467.6) and mortality rates (165.5; 95% CI, 164.9-166.1) among Appalachian residents were significantly higher (5.6% and 12.8%, respectively) than among non-Appalachian residents. Within Appalachia, the Central subregion-predominantly eastern Kentucky-had the highest rates of all-site cancer incidence (495.9) and mortality (201.9). In addition, the Central subregion had the highest rates of lung and colorectal cancer incidence, and the highest rates of lung, colorectal, and cervical cancer mortality. All-site cancer incidence and mortality rates among Appalachian individuals have decreased significantly since 2004 (-0.33%/year and -1.39%/year, respectively), with site-specific incidence rate decreases for late-stage lung (-2.19%/year), late-stage colorectal (-0.75%/year) and late-stage female breast (-0.35%/year) cancers in Appalachia. While cancer incidence and mortality rates are declining in Appalachia, they remain substantially higher and demonstrate slower progress than elsewhere in the US-particularly in the Central Appalachian subregion-indicating the need for targeted research to delineate and address the factors driving these cancer health disparities.

Substance Use Disorder and Harm Reduction Curriculum in United States and Canadian Undergraduate Medical Education: An Online Survey.

Substance use disorders (SUD) are a significant public health challenge, necessitating that clinicians are trained in SUD treatment and harm reduction (HR) strategies. Despite this, no studies have assessed the extent of SUD and HR training across all medical schools. This study assesses the current state of SUD and HR curriculum among medical students in the United States and Canada. From May to July 2023, we conducted an anonymous online survey via email invitation to student affairs' offices of all 220 accredited US and Canadian medical schools. The survey assessed the curricula students were exposed to related to SUD treatment, HR, and stigmatizing attitudes. A sample of 568 students from 52 medical schools (23.6% of all US and Canadian medical schools) completed the survey. Participants reported that in their medical school they were taught about: recognition of an opioid overdose (80.0%), identifying and treating opioid withdrawal (68.2%), principles and practices of HR (60.6%), administering naloxone (56.6%), the importance of syringe service programs (51.8%), prescribing methadone and/or buprenorphine (29.5%), and counseling patients on safe injection practices (11.4%). In addition, participants reported that they were taught: how to identify drug-seeking behavior (36.4%), that people who use heroin are "drug abusers" (24.4%), to withhold opioid pain medication from patients who are known or suspected to use drugs (15.9%), and that medication for opioid use disorder is another form of addiction (12.6%). We found large curricular gaps related to the administration of medications for opioid use disorder and treating opioid overdose and withdrawal, as well as a significant prevalence of stigmatizing attitudes. Renewed efforts are needed to implement comprehensive and destigmatizing SUD curricula. The study is limited by response bias and is expected to overestimate the extent of HR related curriculum, indicating the true gap is likely higher than reported.

Association Between Health Care Discrimination and Medical Mistrust Among Black Assigned Female at Birth Adults with Minoritized Sexual and Gender Identities in the United States.

Purpose: Black sexually and gender minoritized (SGM) people who were assigned female at birth (AFAB) experience compounding health care inequities, barriers to equitable care, and disproportionately adverse health outcomes. Given prior literature indicating that both experienced and/or anticipated reported health care discrimination and medical mistrust may shape these health care experiences of Black SGM AFAB people, we sought to investigate the specific interplay between these two factors to bolster understanding of their relationship. Methods: In January and February 2023, we conducted a cross-sectional online survey of 156 Black SGM AFAB adults in the United States (U.S.) assessing their reported lifetime experiences of all-cause and gender-, race/ethnicity-, and weight-based discrimination in health care settings, in addition to their ratings of medical mistrust on the Medical Mistrust Index (MMI). Univariate statistics, analysis of variance, post hoc pairwise tests, and multivariable linear regression were conducted to assess measures of health care discrimination, medical mistrust, and covariates and their associations among the analytic sample (n = 130). Results: Most participants reported prior experiences of health care discrimination. Adjusting for demographic, socioeconomic, and health care factors, we identified an association between experiencing any-cause-, race/ethnicity-, or weight-based discrimination and significantly higher MMI scores. The association for gender-based discrimination was not statistically significant. Conclusion: Black SGM AFAB people who experience any-cause-, race/ethnicity-, or weight-based discrimination may be more likely to experience higher levels of medical mistrust. Identifying interventions and pathways to tackle health care discrimination and the systemic and structural drivers of medical mistrust will be critical to augmenting health care outcomes and experiences of Black SGM communities.

Child marriage in high-prevalence countries: publication trends in SCI-E and SSCI journals and future recommendations

ABSTRACT Child marriage is a significant public health issue that endangers the health of both the married children and their offspring. This phenomenon is often associated with gender inequality, with women being disproportionately affected. This study aimed to conduct a bibliometric analysis to identify underresearched subfields in regions where child marriage is prevalent, thereby providing insights to guide future research endeavors. The data comprising 239 publications were obtained from the Web of Science Core Collection database. Bibliometric indicators such as academic collaboration between countries, annual growth of publications, research areas, citation topics, top 10 journals, and research themes were presented. Bibliometric analyses and visualizations were performed using VOSviewer. Of the total data, 93.3% (N: 226) were published in the last decade. The United States was the most studied country, while limited documents were found for Mexico and China among the investigated countries. Additionally, Iran was observed to have limited collaboration with other countries. Child marriages were investigated primarily in terms of public health. Gender & Sexuality studies and Psychiatry & Psychology were the most frequently cited meso-level topics. The publications were grouped into three clusters based on their themes, which included reproductive health, public health and violence. The United States was identified as a country that is particularly sensitive to this topic. However, it has not fully addressed some particularly risky regions such as Mexico, China, and Iran. The subject was primarily discussed from the perspectives of gender equality, public health, and reproductive health. However, productivity in the psychiatric aspect of the issue was found to be inadequate in the dataset, despite the notable scientific interest in this area.

The soft power cost of COVID-19 in OECD countries: a lose–lose outcome for China and the United States

One way in which many scholars of public opinion have operationalized a country’s soft power abroad is to measure how favorably that country is viewed by people in foreign countries. While earlier research has demonstrated the mechanisms and factors correlated with how foreigners perceive a country, much less is known about how sudden and unexpected global events may impact how favorably citizens of different countries view another country. Analyzing recent Pew Global Attitudes Survey data, we assess how the COVID-19 pandemic changed public opinions of China and the United States—with Russia as a reference—in 12 OECD countries. Our analysis reveals that COVID-19 led to a decline in favorability toward both the US and China—the ‘soft power cost’ of COVID-19. While the cost is larger for China than for the US in most countries, we observe exceptions in Germany, Italy, and South Korea. We also explore the heterogeneity of the soft power cost by respondents’ individual attributes and other attitudes such as how COVID-19 impacted their lives.

Are lead independent directors greener? Evidence from climate change commitment and ESG performance

PurposeThis paper sheds light on how appointing a lead independent director (LIDIR) affects a firm’s commitment to climate change and to what extent environmental, social and governance (ESG) performance is affected by a firm’s commitment to climate change in the presence of a LIDIR.Design/methodology/approachThe authors utilise ordinary least squares (OLS) and a sample of 12,236 firm-year observations in the United States of America (USA) over the 2002–2019 period to test the predictions. The authors also apply alternative research designs such as propensity score matching, Heckman two-step and instrumental variable techniques to address endogeneity concerns.FindingsThe authors find that a LIDIR representation on the board is positively associated with a firm’s commitment to climate change. The authors also find that the association between a LIDIR representation on the board and a firm’s commitment to climate change is more pronounced in firms with a combined chief executive officer (CEO) and board chair positions than firms with both positions separated. Additional analysis suggests that increased commitment to climate change in the presence of a LIDIR improves ESG performance.Originality/valueWhile the effect of a LIDIR on firm financial outcomes has received much attention, there is a lack of empirical evidence on whether lead independent directors are greener. The authors provide new and important contribution to the literature by investigating the relationship between an LIDIR representation on the board and non-financial outcomes from the perspective of climate change commitment and ESG performance. The findings may be informative to policymakers seeking to deal with climate change impacts on society to encourage the appointment of a LIDIR.

Low prevalence of methotrexate intolerance in rheumatoid arthritis: a South African study.

Methotrexate (MTX) is the first line therapy for rheumatoid arthritis (RA), and despite its widespread use, there is very little information about MTX intolerance in sub-Saharan Africa. The aim of this study was to assess the prevalence of MTX intolerance and other reasons for stopping MTX in RA in South Africa. A retrospective chart review of all RA patients seen at Inkosi Albert Luthuli Hospital in Durban from 2009 to 2019 was undertaken. We included patients who received MTX for at least three months. All patients received folic acid supplements. Patients who discontinued MTX were categorized as having either MTX related toxicity or other reasons. A total of 695 patients were identified with a female to male ratio of 7:1. The mean age was 57.9 (± 13.3) years, and median duration of MTX use was 67.0 (39.0-106.0) months. Most of the patients were African Blacks (61.2%), and Indians (32.8%). There were 83 (11.9%) patients who stopped MTX, and it was successfully reintroduced in 25 of them. Thus, 58 (8.3%) patients discontinued therapy, 33 (4.7%) due to intolerance and 25 (3.6%) due to factors other than adverse effects. The commonest causes of MTX intolerance were respiratory, gastrointestinal and haematological. The other reasons for discontinuation included co-morbidities and pregnancy related concerns. The low prevalence of MTX intolerance in a multiethnic population in this single centre study, confirms the value of MTX as anchor therapy, especially in resource constrained settings. Key Points • We report a low and similar prevalence of methotrexate intolerance in a large population of African Blacks and Indians with RA in sub-Saharan Africa. • Even though there was heterogeneity among other studies, our review indicates that MTX was tolerated better in our patients compared to patients in Europe and the United States of America.

The changing burden of gout in adults aged 70 and above based on the global burden of disease 2019

IntroductionGout is a significant global health issue, particularly among adults aged 70 and above. Understanding its epidemiological evolution and associated factors is crucial for guiding interventions and improving management.MethodsThis study analyzed data from the Global Burden of Disease study to assess the prevalence and trends of gout among adults aged 70 and above from 1990 to 2019. We evaluated temporal trends and regional disparities by calculating the estimated annual percentage change (EAPCs).ResultsGlobally, the number of older adults individuals affected by gout increased from 5,316,210 cases in 1990 to 15,666,063 cases in 2019. It is noteworthy that the global burden of gout among the older adults continued to rise from 1990 to 2019, with an EAPC of 1.17 (95% CI: 1.02 to 1.32). In 2019, the prevalence rates among individuals aged 70–74, 75–79, 80–84, and 85 and above were 3,121.31 per 100,000, 3,437.17 per 100,000, 3,592.38 per 100,000, and 3,726.91 per 100,000, respectively. The regions with the highest prevalence rates of gout in 2019 were Australasia, High-income North America, and Southern Latin America, with rates of 8,500.73, 8,351.33, and 4,666.87 per 100,000, respectively. At the national level, some developed countries such as New Zealand, the United States of America, and Australia had the highest prevalence rates, reaching 8,893.74, 8,508.06, and 8,427.94 per 100,000, respectively. It is noteworthy that regions with higher levels of Socio-Demographic Index tended to have relatively higher burden of gout among the older adults, and the prevalence rates varied across different regions and age groups.ConclusionThe study underscores the persistent burden of gout among the older adults, emphasizing the need for targeted interventions to address this issue and improve public health outcomes in this demographic.

The impact of globalisation on economic systems and social structures

The study's relevance is stipulated by the need to understand the impact of globalisation on economic systems and social structures in the context of countries' uneven development. This study aims to analyse the effect of globalisation on economic systems and social structures in ten countries with different levels of economic growth. The study uses three empirical methods: regression analysis, comparative data analysis, and correlation analysis to identify the relationships between economic indicators. The statistical data were obtained from the World Bank, IMF, and national statistical agencies. Regression analysis has shown that every 1% increase in the share of high-tech exports in the GDP of developed countries contributes to a 0.5% increase in their economic growth. In developed countries like the United States and Germany, high innovation and urbanisation stimulate sustainable economic development and reduce CO₂ emissions by 12% per capita. In developing countries like Ukraine and Kenya, insufficient innovation and weak urbanisation lead to limited economic progress and an 8% increase in CO₂ emissions. The study's findings highlighted the importance of investing in innovation and urban infrastructure for sustainable development. For example, introducing high-tech export support programmes in developing countries can increase economic efficiency and reduce environmental impact. Policy strategies should focus on fostering innovation clusters and improving urban infrastructure to balance social and environmental challenges. The study provides an essential basis for strategic decision-making aimed at achieving sustainable development, increasing competitiveness and reducing the environmental burden on a global scale.

“Do you feel you’re being seen?”: Black women undergraduates’ experiences with mentorship

PurposeRace and gender – and their intersection – play an important role in mentorship. In the current study, informed by critical race theory (CRT) and intersectionality, we identified and explored helpful and harmful mentoring experiences among Black women undergraduates.Design/methodology/approachSemi-structured qualitative interviews were conducted with Black female undergraduate students (n = 18) from five undergraduate institutions in the United States. Interviews were recorded and transcribed, a codebook was developed through a series of team meetings, and inductive qualitative coding was performed.FindingsEight major themes were revealed, with three indicating positive mentorship experiences and five indicating negative mentorship experiences. Participants expressed appreciation for effective mentor support concerning professional development, personal concerns, and race-specific support. Experiencing ineffective mentorship compounded other systemic barriers that the participants faced and led them to censor their self-expression while communicating with their mentors.Originality/valueThis examination of mentoring perspectives from Black women undergraduate students provides a foundation for future directions in mentorship improvement for Black women.

Competitiveness And Competitive Strategies

The business competitiveness is one of the most recurrent study topics in the last century and a matter of great concern in Latin American countries, given the changing conditions of the markets. This article aims to analyze the relationship between the strategic management of organizations and business competitiveness in order to validate the most significant actions that medium and small-sized enterprises in Colombia can adopt. A descriptive bibliometric analysis of publications in Scopus on strategic management and competitiveness was conducted. VosViewer was used to determine the co-occurrence between terms and authors. In the chosen database, 7,877 publications were found, of which 7,134 correspond to strategic management and 743 to business competitiveness. The data show that scientific production on strategic management was primarily concentrated in the years 2019 and 2023, with 583 and 586 publications, respectively (508 on average per year), while in business competitiveness, the years 2020 and 2021 had the highest outputs, with 75 and 77 publications, respectively (55 on average per year). At a global level, the countries with the highest productivity in publications, based on the search equations, are the United States, China, and the United Kingdom, with 320, 128, and 122 publications, respectively, during the period from 2013 to 2023, totaling 2,649 authors cited in cross-references. Thus, it is concluded that, based on the bibliometric analysis conducted in VosViewer using the search equations, co-occurrences were identified in 275 keywords across 11 clusters, which link the concepts of business competitiveness with competitive strategy, strategic resources, organizational competitive dynamics, and strategic planning. Essentially, these co-occurrences allow a holistic, systemic, and complex approach to the topic of strategic business competitiveness in the current environments faced by SMEs, characterized by unpredictability, disruption, and turbulence. The limitations identified in the development of this bibliometric analysis are based on the identification and application of a systematic literature review methodology, which enables an effective and concise bibliometric analysis. Additionally, the potential research areas that can be addressed include strategic business competitiveness, applicable to all micro, small, and medium-sized enterprises.

What makes an American “classic”?

American “classics,” and “classic” definitions of America and its people, are often tied to an apparently inescapable, ineffable sense of greatness. MAKE AMERICA GREAT AGAIN has resurfaced as the mantra of 2025, with the newly elected President’s promise to restore a broken nation, elevating it above time, and in defiance of his own criminal record, even above the law. The slogan echoes some of the tones, if not the politics, of the preface of Leaves of Grass (1855), when Walt Whitman wrote, “The United States themselves are essentially the greatest poem…”

Reprinted Excerpt from Writing Backwards: Historical Fiction and the Reshaping of the American Canon (2023)

Alexander Manshel talks to the editors about his first book, Writing Backwards: Historical Fiction and the Reshaping of the American Canon (Columbia University Press, 2023), part of which is reprinted here with his permission (Chapter 2: The Making of the Greatest Generation). As the author writes, the book argues that over the last forty years the American literary field has transformed to celebrate narratives of the historical past over all other literary genres. In this period, key literary institutions—from the National Endowment for the Arts to major literary prizes and university English departments—have worked to promote the idea that historical fiction is singular in its artistic seriousness, its pedagogical utility, and its political potency. This shift in literary value has gone hand in hand with the increasing recognition and canonization of Black, Asian American, Latinx, and Indigenous writers in the United States: that is, the vast majority of minoritized writers who have been consecrated by these institutions over the last four decades have been celebrated for writing about the historical past.

The evolving landscape of laser-based skin cancer prevention.

In the United States, 1 in 5 Americans develop keratinocyte carcinoma (KC) by age 70, placing the disease among the five most expensive cancers based on Medicare expenditure. Current preventative measures have failed to stem rising KC rates, highlighting the need for alternative strategies. Evolving evidence indicates that lasers conventionally used to treat photoaging, may provide protective effects against the development of KC and precursor lesion, actinic keratosis (AK). This review first delves into existing evidence on fractional infrared laser-based KC and AK prevention. Next, the work discusses potential underlying mechanisms that might explain fractional infrared lasers' prophylactic effects. A comprehensive literature search of PubMed and Web of Science databases was conducted from inception to April 2024 using preselected search terms. Interventional human and animal studies, epidemiological analyses, and case reports on fractional infrared laser-based prevention of KC or AK were screened according to predefined inclusion/exclusion criteria. Included evidence demonstrates that ablative fractional lasers reduce and delay development of AK/KC, shown in two controlled trials of photodamaged patients and two murine studies (i.e. Er: YSGG and CO2 lasers). Weaker evidence of KC prevention by nonablative infrared lasers is provided by a retrospective cohort study. In the laser literature, three mechanisms are proposed to drive these prophylactic effects, including the ability of infrared lasers to (i) remove DNA-damaged epidermal cells, (ii) activate the insulin-like growth factor-1 pathway by reducing fibroblast senescence, and (iii) initiate immunomodulating effects. Based on current evidence, infrared fractional lasers show promise particularly for secondary KC prevention in photodamaged populations.

A Cure for Type 1 Diabetes: Are We There Yet?

Type 1 diabetes (T1D) affects over 2 million people in the United States and has no known cure. The discovery and first use of insulin in humans 102 years ago marked a revolutionary course of treatment for the disease, and although the formulations and delivery systems have advanced, insulin administration remains the standard of care today. While improved treatment options represent notable progress in T1D management, finding a functional cure for the disease remains the ultimate goal. Approaches to curing T1D have historically focused on blunting the autoimmune response, although sustained effects of immune modulation have proven elusive. Islet transplant therapies have also proven effective, although a lack of available donor tissue and the need for immunosuppression to prevent both host-graft rejection and the autoimmune response have reserved such treatments for those who already require immunosuppressive regimens for other reasons or undergo severe hypoglycemic events in conjunction with hypoglycemic unawareness. With the advent of human stem cell research, the focus has shifted toward generating an abundance of allogeneic, functional beta-like cells that can be transplanted into the patients. Immunoisolation devices have also shown some promise as a method of preventing immune rejection and the autoimmune destruction of transplanted cells. Finally, advances in new immune therapies, if used in the early stages of T1D progression, have proven to delay the onset of diabetes. Stem cell-based therapies are a promising approach to curing T1D. The ongoing clinical trials show some success, although they currently require immunosuppressant agents. Encapsulation devices provide a method of immunoisolation that does not require immunosuppression; however, the devices tested thus far eventually lead to cell death and fibrotic tissue growth. Substantial research efforts are underway to develop new approaches to protect the stem cell-derived beta cells upon transplantation.