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Background Emerging evidence demonstrates that surveillance of individuals at high-risk (HRIs) of developing pancreatic adenocarcinoma allows for identification and treatment of resectable tumors with improved survival. Population-based data suggest that hyperglycemia may be present up to three years before the development of pancreatic cancer. We investigated whether elevated hemoglobin A1c (HbA1c) is associated with the development of pancreatic cysts in a pancreatic surveillance program. Methods We performed a retrospective study of HRIs who underwent pancreatic surveillance at a single institution between May 2013 and March 2019, according to published criteria. We collected demographic information, clinical data including HbA1c, and imaging results. We compared data using univariable and multivariable analyses. Our primary outcome was the presence of pancreatic cysts on initial surveillance in patients with elevated HbA1c. Results Ninety-eight patients underwent surveillance imaging via EUS or MRCP and seventy-four patients met inclusion criteria. Thirty patients were found to have cysts on initial imaging. Older age ( p  < 0.01) and HbA1c in the prediabetic range or higher ( p  = 0.01) were associated with the presence of cysts or solid lesions on univariable analysis. After controlling for confounders, age (aOR 9.08, 95% CI 2.29–36.10), and HbA1c > 5.7% (aOR 5.82, 95% CI 1.50–22.54) remained associated with presence of cysts and solid lesions in HRIs. In patients with cysts or solid lesions there was a strong association between increased age and elevated HbA1c ( p  < 0.01). Conclusion HRIs with elevated HbA1c were more likely to have pancreatic cysts compared to individuals with lower HbA1c on initial imaging in a pancreatic surveillance program. These findings may help tailor the surveillance protocols for those at increased risk of developing pancreatic adenocarcinoma.

Background Safety-net clinics are an important source of low-cost or free mental healthcare to those with limited financial resources. Such clinics are often staffed by trainees in early stages of their career. Only limited data exist on best practices in treatment-implementation and on clinical outcomes attained in such clinics. The primary purpose of this article is to describe the design of an outpatient psychiatry student-run free clinic (SRFC) serving uninsured individuals in New York City’s East Harlem neighborhood and to analyze the quality of services provided and the clinical outcomes attained. Methods The authors conducted a retrospective chart review of n  = 69 patients treated in the EHHOP Mental Health Clinic (E-MHC) to describe the demographic and clinical characteristics of the study population. Utilizing Health Effectiveness Data and Information Set metrics, they estimated the likelihoods of patients meeting metric quality criteria compared to those in other New York State (NYS) insurance groups. The authors derived linear mixed effect and logistic regression models to ascertain factors associated with clinical outcomes. Finally, the authors collected patient feedback on the clinical services received using a customized survey. Results Almost all patients were of Hispanic ethnicity, and about half of patients had more than one psychiatric disorder. The clinical service performance of the E-MHC was non-inferior on most measures examined. Factors associated with symptom improvement were the number of treatment sessions and certain demographic and clinical variables. Patients provided highly positive feedback on the mental healthcare services they received. Conclusions SRFCs can provide quality care to vulnerable patients that leads to clinically meaningful reductions in psychiatric symptoms and is well-received by patients.

Introduction: Harm reduction interventions, such as supervised consumption sites, are critical tools to combat the growing overdose crisis, with overdose mortality reaching over 90,000 deaths last year. Efforts have been put forward in several cities across the country to open a legal supervised consumption site, but due to various obstacles, remain unsuccessful. This study seeks to identify and examine the value of supervised consumption sites, understand the continued resistance from the community, as well as the political and legal barriers, and explore the pathways forward.Methods: A qualitative study was conducted through semi-structured recorded interviews of a sample of 12 key informants with expertise in harm reduction and drug policy. Transcripts were analyzed by thematic coding in MAXQDA via inductive content analysis.Results: At the core of the community and political opposition is the stigmatization of people who use drugs. Many participants expressed that supervised consumption sites represent not only a solution to combat overdose, but are just one piece of fighting for social and racial justice for people who use drugs. Other major themes that emerged were the media’s role in influencing public opinion about drug use and supervised consumption sites, legal barriers and the importance of community buy-in before opening a site.Discussion: Stigmatization, moralization and criminalization of people who use drugs and experiencing substance use disorder are at the root of all the major barriers to legal SCSs explored in this study and other progressive drug policies. The results from this study offers strategies to overcome of these social and legal obstacles.

Importance The prognosis for patients with metastatic pancreatic ductal adenocarcinoma (PDAC) is dismal, due in part to chemoresistance. Bacteria-mediated mechanisms of chemoresistance suggest a potential role for antibiotics in modulating response to chemotherapy. Objective To evaluate whether use of peritreatment antibiotics is associated with survival among patients with metastatic PDAC treated with first-line gemcitabine or fluorouracil chemotherapy. Design, Setting, and Participants Using the population-based Surveillance, Epidemiology, and End Results–Medicare linked database, this retrospective cohort study analyzed data for patients diagnosed with PDAC between January 1, 2007, and December 31, 2017. Data analysis was conducted between September 1, 2021, and January 15, 2023. The population-based sample included 3850 patients with primary metastatic PDAC treated with first-line gemcitabine or fluorouracil chemotherapy. Patients who received antibiotics were matched based on propensity scores to patients who did not receive antibiotics. Exposures Receipt of 5 or more days of oral antibiotics or 1 injectable antibiotic in the month before or after beginning first-line chemotherapy. Main Outcomes and Measures Overall survival and cancer-specific survival. The end of follow-up was December 31, 2019, for overall survival and December 31, 2018, for cancer-specific survival. Results Of the 3850 patients treated with first-line gemcitabine (3150 [81.8%]) or fluorouracil (700 [18.2%]), 2178 (56.6%) received antibiotics. The mean (SD) age at diagnosis was 74.2 (5.8) years and patients were predominantly women (2102 [54.6%]), White (3396 [88.2%]), and from metropolitan areas (3393 [88.1%]) in the northeastern or western US (2952 [76.7%]). In total, 1672 propensity-matched pairs were analyzed. Antibiotic receipt was associated with an 11% improvement in overall survival (hazard ratio [HR], 0.89; 95% CI, 0.83-0.96;P = .003) and a 16% improvement in cancer-specific survival (HR, 0.84; 95% CI, 0.77-0.92;P < .001) among patients treated with gemcitabine. In contrast, there was no association between antibiotic receipt and overall survival (HR, 1.08; 95% CI, 0.90-1.29;P = .41) or cancer-specific survival (HR, 1.12; 95% CI, 0.90-1.36;P = .29) among patients treated with fluorouracil. In a subgroup of gemcitabine-treated patients who received antibiotics, nonpenicillin β-lactams were associated with an 11% survival benefit (HR, 0.89; 95% CI, 0.81-0.97;P = .01). Conclusions and Relevance In this cohort study, receipt of perichemotherapy antibiotics was associated with improved survival among patients treated with gemcitabine, but not fluorouracil, suggesting that antibiotics may modulate bacteria-mediated gemcitabine resistance and have the potential to improve PDAC outcomes.

Adult developmental writing students face particular barriers because of their multiple family, community, and work responsibilities. This study describes how these barriers affect the concrete material conditions under which adult students at a mid-western urban university do their writing for college. Particular attention is paid to the time constraints on adult students. Data from surveys and interviews indicate that many students experience material conditions for composing that adversely affect their writing processes. Students' writing sessions are often short, sometimes unplanned, and frequently interrupted. While developmental writing instructors cannot change the concrete circumstances in which students compose, they can offer classroom activities to help students contextualize their writing situations and learning methods of managing the barriers they face.

It is found that reading and writing communities--discussion/research/writing groups--can play a crucial role in helping the female, feminist graduate student negotiate her passage from student to professor.

Aronson describes the exhilaration and anxiety of a contemporary lesbian mothers' group. Aronson, who is a member of the group, describes meetings and outings with the group that gave her a sense of community.

The purpose of this dissertation is to examine how women's gender, race, class, and other identities shape their histories as writers. The project emerges at once from compositionists' recent explorations of how ideology influences writing practices and communities, and feminist concerns with how oppression and resistance are constructed within women's subjectivities. The central question informing the research is the following: Why is it that women feel empowered in certain writing situations and disempowered in others? The study focuses on one group of writers--eight undergraduate reentry women of diverse class and race identities at a Catholic women's college in the Midwest. Case studies were generated from an interpretation of the following data: (1) transcripts of ethnographic interviews with each student; (2) select samples of their academic and non-academic writing; and (3) background interviews with faculty, staff, and students at the college. The ethnographic interviews asked study participants to talk about their histories as writers, to review their educational autobiographies, and to discuss in depth two or three completed writing projects. Interpretation of the data focuses on thematic content, interpersonal dynamics (i.e, between interviewer and interviewee), and narrative structure. Cases studies of these eight writers suggest that experiences of disempowerment occur in three recurring contexts: when participants feel that their writing is derided or unfairly judged; when the boundaries they have set for their writing are violated; and when their expression is severely restricted. These experiences of disempowerment typically occur when participants' gender, class, race, age and other identities place them in unfavorable power positions with respect to their audiences. Cases studies also suggest, however, that participants find means of resisting the damaging effects of these episodes in their writing histories by (1) learning to value and write from their multiple identities; (2) choosing supportive audiences whenever possible or choosing to withhold information about the self from potentially harmful audiences; and (3) finding \"safe\" spaces for writing--e.g., journals and memoirs.