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"Clark, Isabel"
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Argentina
Lonely Planet's Argentina is your passport to the most relevant, up-to-date advice on what to see and skip, and what hidden discoveries await you. Watch enormous icebergs calve from Glaciar Perito Moreno, tour wineries and enjoy the finished product around Mendoza, and hike the rugged Fitz Roy Range for stunning mountain views - all with your trusted travel companion. Get to the heart of Argentina and begin your journey now!
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Investigating the demographics, comorbidities, and postoperative complications and impact of a history of cocaine use in patients undergoing total knee arthroplasty
Introduction
Cocaine is a commonly abused stimulant that can affect surgical outcomes. The purpose of our study is to better understand the associations and effects of a reported history of cocaine use in patients undergoing total knee arthroplasty (TKA) compared to patients with no prior cocaine use.
Methods
558,371 TKA patients were identified from 2016 to 2019 in the National Inpatient Sample (NIS) database using ICD-10 CM/PCS codes. We compared the demographics, comorbidities, postoperative complications, length of hospital stay, and incurred financial charges of 263 TKA patients with a history of cocaine use (group 1) to 558,108 TKA patients with no prior cocaine use (group 2).
Results
Group 1 had a higher percentage of males (
p
< 0.001), lower average age at the time of TKA (
p
< 0.001), and a larger racially Black and Other (
p
< 0.001) population compared to group 2. Group 1 had higher rates of obesity (
p
< 0.001), schizophrenia (
p
< 0.001), mood disorder (
p
< 0.001), and anxiety disorder (
p
< 0.001). However, group 1 had less tobacco use (
p
= 0.002). Group 1 had an increased postoperative rate of acute renal failure (
p
= 0.003, OR = 2.36, CI: [1.32, 4.22]) and periprosthetic infection (
p
< 0.001, OR = 5.37, CI: [3.13, 9.20]) when compared to group 2. Group 1 also spent more days at the hospital (
p
< 0.001) and incurred higher total charges in dollars (
p
< 0.001).
Conclusion
Patients with a reported history of cocaine use were primarily men, Black, and had a lower average age of TKA with significant preoperative comorbidities of obesity, schizophrenia, mood disorder, and anxiety disorder. Cocaine use was associated with extended hospital stays, more expensive charges, and postoperative complications of acute renal failure and periprosthetic infection after TKA. However, more research is needed concerning cocaine dosage, route of administration, and chronicity of usage prior to TKA.
Journal Article
Student and staff experiences of digital dentistry in a Southwest Primary Care Dental School, UK
Introduction
Digital dentistry (DD) is increasingly integrated into clinical practice, yet limited research explores its implementation within undergraduate dental education in the UK. This study examined student and clinical supervisor (CS) experiences of digital intraoral scanning (DIOS) in a primary care dental school.
Methods
A qualitative study using semi-structured online interviews was conducted with 15 Bachelor of Dental Surgery (BDS) students and six CS in a dental school in Southwest England. Data were analysed using template analysis.
Results
Participants viewed DIOS as essential for preparing graduates for contemporary practice, while maintaining competence in conventional techniques. Students described DIOS as engaging, low-stress, and beneficial for patient interaction, whereas CS highlighted technical challenges, variable staff digital literacy, and organisational constraints. Key barriers included limited equipment, restricted access, time pressures, and variability in supervisor training. Reported benefits included improved patient experience, accuracy, and enhanced learning for visually oriented students. Participants recommended increased access, structured training, and broader integration of digital technologies.
Conclusions
DD teaching is positively received by students and valued by CS for preparing graduates for modern practice. However, successful integration requires investment in training, resources, and equitable access, alongside structured curriculum development to support consistent delivery.
Journal Article
Anticoagulant Effect of Snow mountain garlic: In Vitro Evaluation of Aqueous Extract
Snow mountain garlic is traditionally eaten by Himalayan locals for its medicinal properties. Although different species of the genus Allium are known to have other biological effects, such as antiplatelet and antithrombotic activities, little is known about the anticoagulant effect of Snow mountain garlic, a member of the genus Allium. Therefore, the present study examined the in vitro anticoagulant effect of the aqueous extract, the lyophilized aqueous extract, and the isoflavone extract from the lyophilized aqueous extract of Snow mountain garlic in samples from 50 human blood donors. Compared to the control, concentrations of 25, 12.5, and 6.25 mg/100 µL lengthened the clotting times of prothrombin, and concentrations of 25 and 12.5 mg/100 µL lengthened the activated partial thromboplastin time (p ˂ 0.05). The isoflavone extract from the lyophilized aqueous extract containing isoflavones, organosulfur compounds, a polyphenol, and a steroid glycoside showed a significant effect (p ˂ 0.05) on the prothrombin time and the activated partial thromboplastin time at a dose of 20 µL (volume) compared to the control. The results regarding the use of Snow mountain garlic as a preventive measure and aid in treating thromboembolic disease are promising.
Journal Article
Preclinical Evaluation of the Anticoagulant Effect of an Aqueous Extract of Snow Mountain Garlic
Background/Objectives: In the genus Allium, it has been shown that some organosulfate compounds of common garlic and onion have an antiplatelet effect. Still, little is known about the anticoagulant activity of the species, Allium ampeloprasum L., specifically Snow mountain garlic; due to its growth site at 6000 m above sea level at temperatures of −10 °C, it could contain different organosulfate compounds. Methods: This study evaluated the anticoagulant effect of a lyophilized aqueous extract of S. mountain garlic in vivo, toxicity in male Wistar rats for 90 days, and the organosulfate compounds present. Results: There was a significant increase (p < 0.05) in the area under the curve for bleeding time at doses of 500 and 1000 mg/kg/d of lyophilized aqueous extract of Snow mountain garlic and 100 mg/kg/d of acetylsalicylic acid. The ED50 was 366 ± 2.43 mg/kg. For chronic toxicity in vivo, no histopathological alterations were found at doses below 500 mg/kg. On the other hand, organosulfate compounds were found in the lyophilized aqueous extract of S. mountain garlic that had not been documented to have an anticoagulant effect. Conclusions: We conclude that S. mountain garlic contains anticoagulant compounds which may be candidates for the treatment of thrombosis.
Journal Article
Scoring Tool to Predict Need for Early Video-Assisted Thoracoscopic Surgery (VATS) After Pediatric Trauma
Background
No widely used stratification tool exists to predict which pediatric trauma patients may require a video-assisted thoracoscopic surgery (VATS). We sought to develop a novel VATS-In-Pediatrics (VIP) score to predict the need for early VATS (within 72 h of admission) for pediatric trauma patients.
Methods
The pediatric 2017–2020 Trauma Quality Improvement Program database was used and divided into two sets (derivation set using 2017–2019 data and validation set using 2020 data). First, multiple logistic regression models were created to determine the risk of early VATS for patients ≤ 17 years old. Second, the weighted average and relative impact of each independent predictor were used to derive a VIP score. We then validated the score using the area under the receiver operating characteristic (AROC) curve.
Results
From 218,628 patients in the derivation set, 2183 (1.0%) underwent early VATS. A total of 8 independent predictors of VATS were identified, and the VIP score was derived with scores ranging from 0 to 9. The AROC for this was 0.91. The VATS rate increased steadily from 12.5 to 32% then 60.5% at scores of 3, 4, and 6, respectively. In the validation set, from 70,316 patients, 887 (1.3%) underwent VATS, and the AROC was 0.91.
Conclusions
VIP is a novel and validated scoring tool to predict the need for early VATS in pediatric trauma. This tool can potentially help hospital systems prepare for pediatric patients at high risk for requiring VATS during their first 72 h of admission. Future prospective research is needed to evaluate VIP as a tool that can improve clinical outcomes.
Journal Article
Financing Benefits and Barriers to Routine HIV Screening in Clinical Settings in the United States: A Scoping Review
The Centers for Disease Control and Prevention recommends everyone between 13–64 years be tested for HIV at least once as a routine procedure. Routine HIV screening is reimbursable by Medicare, Medicaid, expanded Medicaid, and most commercial insurance plans. Yet, scaling-up HIV routine screening remains a challenge. We conducted a scoping review for studies on financial benefits and barriers associated with HIV screening in clinical settings in the U.S. to inform an evidence-based strategy to scale-up routine HIV screening. We searched Ovid MEDLINE®, Cochrane, and Scopus for studies published between 2006–2020 in English. The search identified 383 Citations; we screened 220 and excluded 163 (outside the time limit, irrelevant, or outside the U.S.). Of the 220 screened articles, we included 35 and disqualified 155 (did not meet the eligibility criteria). We organized eligible articles under two themes: financial benefits/barriers of routine HIV screening in healthcare settings (9 articles); and Cost-effectiveness of routine screening in healthcare settings (26 articles). The review concluded drawing recommendations in three areas: (1) Finance: Incentivize healthcare providers/systems for implementing HIV routine screening and/or separate its reimbursement from bundle payments; (2) Personnel: Encourage nurse-initiated HIV screening programs in primary care settings and educate providers on CDC recommendations; and (3) Approach: Use opt-out approach.
Journal Article
Pathways to Care: How Help-Seeking Behaviors Relate to Duration of Untreated Psychosis and Treatment Engagement
While much research has focused on the relationship between duration of untreated psychosis (DUP) and clinical outcomes in the first episode psychosis (FEP) patient population, little is known about the individual help-seeking episodes (HSE) that patients undergo before receiving appropriate care. The purpose of this project is to better understand how early referral to FEP-specific care and support system differences affect patients’ DUP and engagement with treatment. Data from 50 patients was analyzed at the Early Psychosis Intervention Clinic of New Orleans (EPIC-NOLA) using a modified version of the Pathways to Care Assessments and data captured during clinical care. Patients with their first HSE leading to a referral to EPIC-NOLA (M = 13.3, SD = 11.17) had shorter DUP compared to patients referred after two or more HSEs (M = 29.7, SD = 36. 7), t (38.6) = 2.31, p = .026, 95%CI = 2.0–30.7. One chi-square test revealed a significantly greater proportion of patients referred after one HSE stayed in treatment for 12 months or more. Cluster analysis and independent t-test analyses revealed that patients with hospital pathways (M = 35.00, SD = 39.36) had significantly longer DUP compared to those with self, other and hospital (M = 15.21, SD = 19.07) care pathways. This study supports existing literature that suggest early FEP treatment leads to shortened DUP and longer treatment engagement. Additionally, patients with support systems (people or services) assisting them with help-seeking reach EPIC-NOLA faster, have shorter DUP, and have better treatment engagement.
Journal Article
Pathological disruption of CELF2 shuttling causes neuronal hyperactivity, learning deficits, and seizures
De novo heterozygous variants in CUGBP Elav-like family member 2 ( CELF2 ) have recently been associated with a rare neurodevelopmental disorder, yet the mechanisms linking specific variants to distinct clinical phenotypes remain poorly understood. Here, we reported a cohort of 18 individuals and provided evidence that variants causing CELF2 mislocalization, but not protein-null variants, were associated with seizures. Using proband-derived human cortical neurons and transgenic mouse models, we demonstrated that CELF2 underwent activity-dependent nucleocytoplasmic shuttling in excitatory neurons and that its cytoplasmic retention caused neuronal hyperactivity, elevated seizure susceptibility, and learning and memory deficits. We further found that cytoplasmic CELF2 regulated mRNAs critical for synaptic function and neuronal excitability and implicated in epileptic seizures and intellectual disability. Drug screening further identified AKT signaling as a key regulator of CELF2 nucleocytoplasmic shuttling and a candidate target for reversing neuronal hyperactivity. Together, our findings expand the clinical and genetic spectrum of CELF2-related neurodevelopmental disorders and establish a variant-specific mechanism that links CELF2 mislocalization to neuronal hyperactivity, seizures, and cognitive impairment.
Journal Article
Gendering the Political Economy of Tobacco Agriculture
Tobacco is one of the leading causes of preventable morbidity and premature mortality worldwide. In order to strengthen tobacco control and non-communicable disease (NCD) prevention in general, tobacco supply, specifically the farming of tobacco by smallholder tobacco farming families throughout Lower- and Middle- Income countries, must be addressed. This thesis seeks to understand perspectives on the lives and livelihoods of these farmers, and how their household dynamics can be connected to macro-level political economic trends. This thesis draws from and contributes to fields of political economy, international development, feminist studies, and tobacco control. It will address the linkage between the gendered dynamics of agricultural production, with specific emphasis on tobacco farming, and the political economy of tobacco control. To contribute to these aims, two studies were conducted. The first is a scoping review examining the use of gender in political economy of agriculture literature, and the second is a qualitative study on gendered dynamics of tobacco farming households in Mozambique.
Dissertation