Davenportmcgee2514

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Data on long-term tenofovir alafenamide (TAF) therapy for pregnant women with active chronic hepatitis B (CHB) (immune clearance and reactivation phases, currently and previously diagnosed) and their infants are lacking.

Pregnant women with active CHB treated with TAF and tenofovir disoproxil fumarate (TDF) were enrolled in this multicenter prospective study, and infants received immunoprophylaxis. The primary outcomes were rates of adverse (safety) events in pregnant women and defects in infants and fetuses. The secondary outcomes were virologic responses in pregnant women, infants' safety, hepatitis B surface antigen (HBsAg) status, and growth conditions.

One hundred three and 104 pregnant women were enrolled and 102 and 104 infants were born in the TAF and TDF groups, respectively. In the TAF group, the mean age, gestational age, alanine aminotransferase level, and viral loads at treatment initiation were 29.3 years, 1.3 weeks, 122.2 U/L, and 5.1 log

IU/mL, respectively. TAF was well-tolerated, and the most common adverse event was nausea (29.1%) during a mean of 2 years of treatment. Notably, 1 (1.0%) TAF-treated pregnant woman underwent induced abortion due to noncausal fetal cleft lip and palate. No infants in either group had birth defects. In the TAF group, the hepatitis B e antigen seroconversion rate was 20.7% at postpartum month 6, infants had normal growth parameters, and no infants were positive for HBsAg at 7 months. The TDF group had comparable safety and effectiveness profiles.

TAF administered throughout or beginning in early pregnancy is generally safe and effective for pregnant women with active CHB and their infants.

TAF administered throughout or beginning in early pregnancy is generally safe and effective for pregnant women with active CHB and their infants.

The effectiveness of hepatocellular carcinoma (HCC) surveillance is mitigated by underuse in clinical practice, highlighting a need for interventions. We evaluated the effectiveness of mailed HCC surveillance outreach to promote HCC surveillance in patients with cirrhosis.

We conducted a multicenter pragmatic randomized clinical trial comparing mailed outreach for surveillance ultrasound (n= 1436) and usual care with visit-based surveillance (n= 1436) among patients with cirrhosis at 3 health systems (tertiary care referral center, safety net health system, and Veterans Affairs medical center) from April 2018 to December 2019. The primary outcome of this interim analysis was guideline concordant semiannual HCC surveillance over a 12-month period and a secondary outcome was proportion time covered by surveillance. All patients were included in intention-to-screen analyses.

Compared with usual care, the outreach arm had significantly higher semiannual surveillance (35.1% vs 21.9%) and lower no-surveillancect across most examined subgroups. Continued follow-up is ongoing to determine if these increases in surveillance translate into improved downstream outcomes includi.ng early HCC detection and curative treatment receipt. (ClinicalTrials.gov, Numbers NCT02582918 and NCT03756051).Lipoxygenases (LOXs) biosynthesize lipid mediators (LMs) as human signaling molecules. Among LMs, specialized pro-resolving mediators (SPMs) are involved in the resolution of inflammation and infection in humans. Here, the putative LOX from the bacterium Sphingopyxis macrogoltabida was identified as arachidonate 9S-LOX. The enzyme catalyzed oxygenation at the n-12 position of C20 and C22 polyunsaturated fatty acids (PUFAs) to form 9S- and 11S-hydroperoxy fatty acids, which were reduced to 9S- and 11S-hydroxy fatty acids (HFAs) by cysteine, respectively, and it catalyzed again oxygenation at the n-6 position of HFAs to form 9S,15S- and 11S,17S-DiHFAs, respectively. The regioselective residues of 9S-LOX were determined as lle395 and Val569 based on the amino acid alignment and homology models. The regioselectivity of the I395F variant was changed from the n-12 position on C20 PUFA to the n-6 position to form 15S-HFAs. This may be due to the reduction of the substrate-binding pocket by replacing the smaller Ile with a larger Phe. The V569W variant had a significantly lower second‑oxygenating activity compared to wild-type 9S-LOX because the insertion of the hydroxyl group of the first‑oxygenating products at the active site was seemed to be hindered by substituting a larger Trp for a smaller Val. The compounds, 11S-hydroxydocosapentaenoic acid, 9S,15S-dihydroxyeicosatetraenoic acid, 9S,15S-dihydroxyeicosapentaenoic acid, 11S,17S-hydroxydocosapentaenoic acid, and 11S,17S-dihydroxydocosahexaenoic acid, were newly identified by polarimeter, LC-MS/MS, and NMR. 11S,17S-DiHFAs as SPM isomers biosynthesized from C22 PUFAs showed anti-inflammatory activities in mouse and human cells. Our study contributes may stimulate physiological studies by providing new LMs.

Adult critically ill patients are prone to complications when receiving enteral nutrition, including feeding intolerance. Although abdominal massage is an effective intervention, its effects on enteral nutrition complications in adult critically ill patients are controversial.

To summarize and evaluate the effect of abdominal massage on enteral nutrition complications in adult critically ill patients.

We searched databases (e.g., PubMed, the Cochrane Library, Embase, and Web of Science) from inception until November 2020 for relevant studies published in English. The methodological quality of selected studies was assessed with the Cochrane Risk of Bias 2.0 tool. And we used of PRISMA 2020 guidelines. The meta-analysis results were reported as mean difference (MD) and events, and the heterogeneity of the studies was evaluated using I

.

Seven studies including 472 participants (aged≥18 years) met the inclusion criteria. The mean gastric residual volume (GRV) (MD=-42.41, 95% confidence interval [CI] -71mall number of patients examined, and short intervention periods, further randomized controlled trials are needed that use accurate methodology, longer interventions, and larger sample sizes to confirm the effect of abdominal massage on feeding intolerance in adult critically ill patients.

Emergency department and urgent care (ED/UC) visits for common conditions can be more expensive with less continuity than office care provided by primary care physicians.

We used quality-improvement methods to enhance telephone triage for pediatric patients by adding additional "Phone First" services including (a) enhanced office-hours telephone triage and advice with available same-day appointments (b) follow-up calls to parents of children self-referred to an ED/UC, and (c) parent education to telephone the office for advice prior to seeking acute care. We hypothesized that enhanced office services would reduce ED/UC utilization and cost. We compared changes in ED/UC encounter rates between intervention and regional practices for four years (2014-2017) using general linear models, and evaluated balancing measures (after-hour phone calls, acute care phone calls, acute care visits, well child visits) for Medicaid-enrolled and commercially-insured children.

The study practices dramatically increased office-hours acute care phone triage and advice which correlated with 23.8-80.5%, (p< 0.001) reductions in ED/UC rates for Medicaid-enrolled children. Office acute care visits decreased modestly. ED/UC visits did not decrease for children in the comparison region. In phone surveys, 94% of parents indicated satisfaction with the ED/UC follow-up call. The decrease in ED/UC visits resulted in an estimated annual cost of care savings for Medicaid-enrolled children in 2017 of $12.61 PMPM which projected to $169 million cost of care savings in Colorado and $6.8 billion in the US.

"Phone First" services in pediatric practices during office-hours reduced ED/UC encounters and cost of care for Medicaid-enrolled children.

"Phone First" services in pediatric practices during office-hours reduced ED/UC encounters and cost of care for Medicaid-enrolled children.

To explore pediatric residents' perspectives on humanism and how residency impacts humanism formation.

We conducted a qualitative study with pediatric resident focus groups at Stanford. Transcripts were analyzed by two investigators using grounded theory. Subsequent literature review led us to adapt Cruess et al. 2015's professional identity formation framework to describe development of a humanism identity in residency. Member check was done to verify themes and the adapted framework.

32 pediatric residents participated. Five themes emerged 1) Empathy, compassion, and respect are foundational elements of humanism. 2) Each resident had a unique view of humanism derived from personal values. 3) Residents felt that the terms excellence and resilience (Gold Foundation IECARES model) did not fit with their own definitions. 4) Residents felt that humanism is a central part of their practice and training. 5) The demands, structure, and culture of residency were often in conflict with promoting humanism in residents. Based on residents' perspectives, we modified the professional identity formation and socialization conceptual framework proposed by Cruess et al. 2015 to reflect humanism identity formation during pediatrics residency. The new framework emphasizes the increased power of the healthcare system and unconscious acquisition on humanism formation in residency as compared to medical school.

Residents believe that humanism is a core part of practicing medicine and should be reinforced during residency training. Cruess' professional identity and socialization framework is a tool for a better understanding of the complexity of humanism development in residency.

Residents believe that humanism is a core part of practicing medicine and should be reinforced during residency training. Cruess' professional identity and socialization framework is a tool for a better understanding of the complexity of humanism development in residency.

To describe the current processes and priorities for pediatric chief resident (CR) selection, to characterize pediatric CR demographics in the past 5 years nationally, and to identify opportunities for addressing bias in the process of pediatric CR selection.

We used a cross-sectional study design with an anonymous national survey of pediatric program directors (PDs) through a web-based platform in January 2020.

A total of 92 of 200 (46%) of PDs responded. About 16% of CR are underrepresented in medicine (UIM) by race/ethnicity. The influential factors most commonly cited in selection were nominations from faculty (84%) and peers (77%), followed by fit with other co-chiefs (68%). Only 17% reported having a specific method to mitigate bias in CR selection, most commonly involving multiple stakeholders in the process.

Current CR selection relies on processes with the potential to introduce bias. Programs have opportunities to address bias in the CR selection process by reevaluating methods vulnerable to bias, including peer/faculty nominations, fit with peers, ITE scores, and assessments through the use of more objective selection tools.

Current CR selection relies on processes with the potential to introduce bias. Programs have opportunities to address bias in the CR selection process by reevaluating methods vulnerable to bias, including peer/faculty nominations, fit with peers, ITE scores, and assessments through the use of more objective selection tools.