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Summary: Background: There is minimal experience in continuous glucose monitoring (CGM) among underserved racial/ethnic minority populations with or at risk of type 2 diabetes (T2D), and therefore a lack of CGM-driven insight for these individuals. We analyzed breakfast-related CGM profiles of free-living, predominantly Hispanic/Latino individuals at-risk of T2D, with pre-T2D, or with non-insulin treated T2D. Methods: Starting February 2019, 119 participants in Santa Barbara, CA, USA, (93 female, 87% Hispanic/Latino [predominantly Mexican-American], age 54·4 [±12·1] years), stratified by HbA1c levels into (i) at-risk of T2D, (ii) with pre-T2D, and (iii) with non-insulin treated T2D, wore blinded CGMs for two weeks. We compared valid CGM profiles from 106 of these participants representing glucose response to breakfast using four parameters. Findings: A “northeast drift” was observed in breakfast glucose responses comparing at-risk to pre-T2D to T2D participants. T2D participants had a significantly higher pre-breakfast glucose level, glucose rise, glucose incremental area under the curve (all p

This article is concerned with an institutional initiative designed to encourage the development of an outreach culture which can support fairer, more equal, access to higher education (HE) in India. The initiative constituted the final impact phase of a 5-year Fair Chance Foundation (FCF) research project (2017-2022) which explored gendered pathways to fair access to HE in the northern Indian state of Haryana. We present the methodology used to prepare a toolkit, named an Outreach Activity Resource (OAR), which enabled staff in government colleges in Haryana to plan and conduct pilot 'taster days'. The article provides an assessment of the outcome of these events. It argues that a practitioner as researcher methodology and a collaborative 'bottom up' research approach provide the basis for the development of contextually appropriate outreach activities to support fairer, more equal, access to higher education (HE). We argue that the adoption of 'top down' initiatives, in very different economic, social and cultural contexts to the those where they were originated, may fail to address the way in which the local 'problem' presents itself and may hinder the development of a contextually informed outreach culture which will support fairer, more equal access to HE. In contrast, initiatives such as the one presented here can contribute essential locally informed expertise, built on contextually informed research, to national and international policy making in relation to widening access to HE in an era in which massification is extending across the globe.

Aims: Shoulder arthroplasty is effective in the management of end-stage glenohumeral joint arthritis. However, it is major surgery and patients must balance multiple factors when considering the procedure. An understanding of patients’ decision-making processes may facilitate greater support of those considering shoulder arthroplasty and inform the outcomes of future research. Methods: Participants were recruited from waiting lists of three consultant upper limb surgeons across two NHS hospitals. Semi-structured interviews were conducted with 12 participants who were awaiting elective shoulder arthroplasty. Transcribed interviews were analyzed using a grounded theory approach. Systematic coding was performed; initial codes were categorized and further developed into summary narratives through a process of discussion and refinement. Data collection and analyses continued until thematic saturation was reached. Results: Two overall categories emerged: the motivations to consider surgery, and the information participants used to inform their decision-making. Motivations were, broadly, the relief of pain and the opportunity to get on with life and regain independence. When participants’ symptoms and restrictions prevented them enjoying life to a sufficient extent, this provided the motivation to proceed with surgery. Younger participants tended to focus on maintaining employment and recreational activities, and older patients were eager to make the most of their remaining lifetime. Participants gathered information from a range of sources and were keen to optimize their recovery where possible. An important factor for participants was whether they trusted their surgeon and were prepared to delegate responsibility for elements of their care. Conclusion: Relief of pain and the opportunity to get on with life were the primary reasons to undergo shoulder arthroplasty. Participants highlighted the importance of the patient-surgeon relationship and the need for accurate information in an accessible format which is relevant to people of different ages and functional demands. Cite this article: Bone Jt Open 2024;5(7):543–549.

Objective SARS-CoV-2 infection during pregnancy has been linked with an increased risk of hypertensive disorders of pregnancy (HDP). The aim of this study was to examine how both trimester and severity of SARS-CoV-2 infection impact HDP.Methods We conducted a cohort study of SARS-CoV-2-infected individuals during pregnancy (n = 205) and examined the association between trimester and severity of infection with incidence of HDP using modified Poisson regression models to calculate risk ratios (RR) and 95% confidence intervals (CI). We stratified the analysis of trimester by severity to understand the role of timing of infection among those with similar symptomatology and also examined timing of infection as a continuous variable.Results Compared to a reference cohort from 2018, SARS-CoV-2 infection did not largely increase the risk of HDP (RR: 1.17; CI:0.90, 1.51), but a non-statistically significant higher risk of preeclampsia was observed (RR: 1.33; CI:0.89, 1.98), in our small sample. Among the SARS-CoV-2 cohort, severity was linked with risk of HDP, with infections requiring hospitalization increasing the risk of HDP compared to asymptomatic/mild infections. Trimester of infection was not associated with risk of HDP, but a slight decline in the risk of HDP was observed with later gestational week of infection. Among patients with asymptomatic or mild symptoms, SARS-CoV-2 in the first trimester conferred a higher risk of HDP compared to the third trimester (RR: 1.70; CI:0.77, 3.77), although estimates were imprecise.Conclusion SARS-CoV-2 infection in early pregnancy may increase the risk of HDP compared to infection later in pregnancy.

Objective: To explore participant-level biological attributes and scan-level methodological attributes associated with retinal nerve fiber layer (RNFL) thickness variability in a population-based sample of elderly United States adults. Design: Cross-sectional analysis using data from the Framingham Heart Study. Participants: One thousand three hundred forty-seven eyes from 825 participants with ≥1 OCT scan and axial length data were included. Methods: Three or more successive RNFL scans of each eye of each participant were obtained in a single session. Multivariable linear mixed models were employed to explore the associations between average RNFL thickness with participant-level biological attributes (age, gender, race, ethnicity, and axial length) and scan-level attributes (signal strength [SS]) as independent variables in the whole population as well as a subsample of adults with no self-reported history of glaucoma. Similar analyses were designed to assess methodological variability with average within-eye standard deviation (SD) for repeated scans as the dependent variable. Main Outcomes Measures: (1) Biological variability: average RNFL thickness, and (2) methodological variability: average within-participant SD across repeated scans. Results: Age (β = −0.19 microns/year, [95% confidence interval {CI}: −0.29, −0.09]), female gender (β = +1.48 microns vs. male, [95% CI: 0.09, 2.86]), axial length (β = −1.24 microns/mm of greater length, [95% CI: −1.80, −0.67]), and SS (β = +1.62 microns/1 unit greater SS, [95% CI: 1.16, 2.09]) were significantly associated with RNFL thickness, while race and ethnicity were not (P > 0.05). In analyses designed to assess methodological variability, higher RNFL thickness (β = +0.02 per micron increase, [95% CI: 0.01, 0.03]), and lower SS (β = +0.19 per 1 unit lower SS, [95% CI: 0.10, 0.27]) were significantly associated with greater RNFL variability. In adults with no self-reported history of glaucoma (n of eyes = 1165, n of participants = 712), female gender was not associated with RNFL, while African American race was associated with thicker RNFL (β = +4.65 microns vs. Whites, [95% CI: 1.28, 8.03]). Conclusions: Retinal nerve fiber layer thickness is lower with older age, male gender, greater axial length, lower SS, and Whites (as compared with African Americans) without self-reported glaucoma. Measurement variability (SD) is higher with greater RNFL thickness and lower SS. Understanding these biological and methodological variations is important to aid in OCT interpretation. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Author(s): Nuryn Aqidah Binte Mohammad Adib [sup.1] , Jagdeep Kaur Sabharwal [sup.1] Author Affiliations: (1) https://ror.org/01y5z8p89, grid.456586.c, 0000 0004 0470 3168, School of Social and Health Sciences, James Cook University, [...], A systematic scoping review was conducted to explore the current evidence on the experience of loneliness influencing well-being among youths. The electronic databases Scopus, APA PsycINFO, Emerald Insight and One Search were used to identify relevant studies, followed by an analysis of the text words contained in the title and abstract, and of the index terms used to describe the article. Reference lists of all shortlisted articles were searched for additional studies. 20 studies (quantitative, qualitative and mixed) published in the English language were identified for inclusion. Findings illustrate that the experience of loneliness is a complex, evolutionary process influenced by relational and environmental factors. Results from the studies identified factors that promote lower experience of loneliness and better well-being in future life stages. Future research can substantiate the issues related to young individuals being socially isolated from others for a prolonged duration.

Introduction: A molecular diagnostic laboratory is the cornerstone of Coronavirus Disease-2019 (COVID-19) disease diagnosis, as the patient’s treatment and management protocol depend on molecular results. Therefore, the laboratory conducting these tests must adhere to quality management process to increase the accuracy and validity of the generated reports. Rajiv Gandhi Super Speciality Hospital established its molecular diagnostic set-up at the beginning of the pandemic. Hence, this study aims to generate quality management data to help improve weak points. Aim: To assess the quality management system for COVID-19 diagnosis. Materials and Methods: This retrospective observational study was conducted at Rajiv Gandhi Super Speciality Hospital in Delhi, India. A total of 14,561 samples were collected over six months, from February 2021 to July 2021. Data from all samples received during this period for COVID-19 Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) testing were included. Data were retrospectively collected from the electronic Laboratory Information Management System (LIMS). Quality variables were analysed over six months from July to December 2021 and classified into preanalytical, analytical, and postanalytical variables. Quality Indicators (QIs) were selected from a common model of QIs set by the International Federation of Clinical Chemistry and Laboratory Medicine. The results were presented in percentages, and descriptive statistics were analysed using Statistical Package for Social Sciences (SPSS) software. Results: During the six-month study period, the molecular laboratory received 14,561 samples. Among the preanalytical variables, sample leakage was the most common cause of sample rejection (134 samples, 0.92%), followed by the non generation of Specimen Referral Form (SRF) identification (76 samples, 0.52%), and non compliance with triple packaging (44 samples, 0.3%). Other preanalytical aspects assessed included incomplete patient identification (17 samples, 0.11%), insufficient sample quantity (12 samples, 0.08%), missing forms/samples (7 samples, 0.04%), samples in the wrong vials/empty Viral Transport Media (VTM) tubes (5 samples, 0.03%), and incomplete LIMS entry (2 samples, 0.01%). Internal Quality Control (QC) was not obtained in 55 samples (0.37%), and two incidents of cross-contamination resulted in false-positive results. Among the postanalytical factors, 11 samples (0.07%) could not be dispatched within the stipulated time frame. Conclusion: The assessment of the quality management system revealed some areas for improvement, emphasising the importance of adhering to QC processes for the smooth operation of diagnostic laboratories, especially those involved in critical reporting. The assessment of QIs helped monitor laboratory parameters effectively.

Introduction: Uveitis-glaucoma-hyphema (UGH) syndrome is an infrequent but severe complication following intraocular lens implantation, characterized by anterior chamber inflammation and elevated intraocular pressure (IOP). This report presents a rare case of late-onset UGH syndrome induced by a well-positioned 1-piece posterior capsular intraocular lens (PCIOL) with a bulb of the haptics extruding through a peripheral capsular tear in a 90-year-old female, 17 years post-cataract surgery. Case Presentation: The patient presented with persistent blurred vision, recurrent anterior uveitis, and uncontrolled IOP despite medical therapy. Extensive evaluation, including ultrasound biomicroscopy, failed to identify the underlying cause, necessitating surgical intervention to control IOP. During concurrent goniotomy and canaloplasty, a PCIOL haptics was discovered protruding through a peripheral capsular tear, establishing the diagnosis. Following PCIOL-haptic amputation and goniotomy and canaloplasty, the patient experienced significant improvement in symptoms and IOP control, with complete resolution of UGH syndrome. Conclusion: This case highlights the necessity of considering atypical causes in persistent postoperative uveitis and IOP elevation and emphasizes the role of surgical intervention in managing complex cases.

Abstract. Background:. Despite the recent emphasis on promoting international collaborations within orthopaedic surgery, criteria for determining the strengths of such partnerships has not been established. The purpose of this study was to evaluate orthopaedic experts' perceptions of the most valuable characteristics of international academic partnerships. Methods:. This study was conducted using a modified Delphi methodology. Experts were identified through the Consortium of Orthopaedic Academic Traumatologists (COACT). Responses were collected from February to September 2022. Three rounds of surveys listing possible topics on a 5-point Likert scale were used to develop consensus among a group of experts. Consensus criteria for topic inclusion in the final scale was determined as a rating of “strongly agree” or “agree” by ≥70% of the participants in the third survey. Results:. The Round 1 survey was distributed to 96 invited participants within the COACT network, of which 50 experts (52.1%) completed the first survey. Consensus was reached on 54 topics organized into the following 5 categories: Research, Advocacy/Leadership, Training/Surgical Skills, Education/Knowledge Exchange, and Sustainability and Safety (RATES Criteria). Conclusions:. Determining the most valuable characteristics of successful international academic partnerships can lead to more sustainable, mutually beneficial collaborations. The criteria identified in this study can provide the foundation for developing new partnerships and assessing existing ones.