المؤلفون: Goldhaber, Nicole H., Qudsi, Rameez A., Polinsky, Samuel, Stupay, Kristen L., Katz, Jeffrey N., Stetson, William B., Dyer, George S. M., Investigators, Co-Principal

المصدر: Global Surgical Education - Journal of the Association for Surgical Education ; volume 2, issue 1 ; ISSN 2731-4588

الوصف: Purpose Arthroscopy is an efficacious and popular treatment modality in developed nations for a variety of musculoskeletal conditions. However, arthroscopy requires specialized training, complex infrastructure, and expensive equipment, occasionally causing barriers to use in developing countries. Consequently, the utilization of resources to perform and teach arthroscopy in low- and middle-income countries (LMICs) is controversial. Through this investigation, we assessed the current capacity and barriers to arthroscopy use and training in these settings. Methods Focused interviews were conducted with surgeons from Haiti (low-income) and Romania (middle-income) regarding their experience with arthroscopy. Based on responses, a multiple-choice survey was developed and administered to orthopaedic trainees and practicing orthopaedic surgeons during national orthopaedics conferences in each country. Results Fifty-eight orthopaedists in Haiti, and 29 in Romania completed the survey. Most (91% from Haiti; 79% from Romania) reported that learning arthroscopy is essential or important for orthopaedic training in their country. Yet only 17% from Haiti compared to 69% from Romania indicated their primary hospital has the equipment necessary for arthroscopy. In Haiti, equipment was the main barrier to use of arthroscopy, followed by training, while in Romania, the main barrier was training, followed by equipment. Simulations and telemedicine were ranked as top choices of effective methods for learning arthroscopy. Conclusions Regardless of their country’s resource limitations, most participants place high value on the practice of arthroscopy and arthroscopic training. The results from this study highlight a hierarchy of needs in developing nations. Furthermore, local providers report a strong belief in the need for arthroscopic treatment to benefit their patients, and a clear desire for further training and development of these techniques. By identifying similarities and differences by location, we may better ...

الإتاحة: https://doi.org/10.1007/s44186-023-00109-5Test

المؤلفون: Kwon, Youngho, Rösner, Heike, Zhao, Weixing, Selemenakis, Platon, He, Zhuoling, Kawale, Ajinkya S., Katz, Jeffrey N., Rogers, Cody M., Neal, Francisco E., Badamchi Shabestari, Aida, Petrosius, Valdemaras, Singh, Akhilesh K., Joel, Marina Z., Lu, Lucy, Holloway, Stephen P., Burma, Sandeep, Mukherjee, Bipasha, Hromas, Robert, Mazin, Alexander, Wiese, Claudia, Sørensen, Claus S., Sung, Patrick

المساهمون: U.S. Department of Health & Human Services | National Institutes of Health, Cancer Prevention and Research Institute of Texas, American Chemical Society, United States Department of Defense | United States Army | Army Medical Command | Congressionally Directed Medical Research Programs, Kræftens Bekæmpelse

المصدر: Nature Communications ; volume 14, issue 1 ; ISSN 2041-1723

مصطلحات موضوعية: General Physics and Astronomy, General Biochemistry, Genetics and Molecular Biology, General Chemistry, Multidisciplinary

الوصف: The tumor suppressor BRCA2 participates in DNA double-strand break repair by RAD51-dependent homologous recombination and protects stressed DNA replication forks from nucleolytic attack. We demonstrate that the C-terminal Recombinase Binding (CTRB) region of BRCA2, encoded by gene exon 27, harbors a DNA binding activity. CTRB alone stimulates the DNA strand exchange activity of RAD51 and permits the utilization of RPA-coated ssDNA by RAD51 for strand exchange. Moreover, CTRB functionally synergizes with the Oligonucleotide Binding fold containing DNA binding domain and BRC4 repeat of BRCA2 in RPA-RAD51 exchange on ssDNA. Importantly, we show that the DNA binding and RAD51 interaction attributes of the CTRB are crucial for homologous recombination and protection of replication forks against MRE11-mediated attrition. Our findings shed light on the role of the CTRB region in genome repair, reveal remarkable functional plasticity of BRCA2, and help explain why deletion of Brca2 exon 27 impacts upon embryonic lethality.

الإتاحة: https://doi.org/10.1038/s41467-023-36211-xTest
https://www.nature.com/articles/s41467-023-36211-x.pdfTest
https://www.nature.com/articles/s41467-023-36211-xTest

المؤلفون: Winter, Amelia R., Collins, Jamie E., Katz, Jeffrey N.

المصدر: BMC Musculoskeletal Disorders ; volume 23, issue 1 ; ISSN 1471-2474

مصطلحات موضوعية: Orthopedics and Sports Medicine, Rheumatology

الإتاحة: https://doi.org/10.1186/s12891-022-05344-3Test

المؤلفون: Edwards, Robert R., Campbell, Claudia, Schreiber, Kristin L., Meints, Samantha, Lazaridou, Asimina, Martel, Marc O., Cornelius, Marise, Xu, Xinling, Jamison, Robert N., Katz, Jeffrey N., Carriere, Junie, Khanuja, Harpal P., Sterling, Robert S., Smith, Michael T., Haythornthwaite, Jennifer A.

المساهمون: national institutes of health

المصدر: BMC Musculoskeletal Disorders ; volume 23, issue 1 ; ISSN 1471-2474

مصطلحات موضوعية: Orthopedics and Sports Medicine, Rheumatology

الوصف: Background Knee osteoarthritis (OA) is among the most common and disabling persistent pain conditions, with increasing prevalence and impact around the globe. In the U.S., the rising prevalence of knee OA has been paralleled by an increase in annual rates of total knee arthroplasty (TKA), a surgical treatment option for late-stage knee OA. While TKA outcomes are generally good, post-operative trajectories of pain and functional status vary substantially; a significant minority of patients report ongoing pain and impaired function following TKA. A number of studies have identified sets of biopsychosocial risk factors for poor post-TKA outcomes (e.g., comorbidities, negative affect, sensory sensitivity), but few prospective studies have systematically evaluated the unique and combined influence of a broad array of factors. Methods This multi-site longitudinal cohort study investigated predictors of 6-month pain and functional outcomes following TKA. A wide spectrum of relevant biopsychosocial predictors was assessed preoperatively by medical history, patient-reported questionnaire, functional testing, and quantitative sensory testing in 248 patients undergoing TKA, and subsequently examined for their predictive capacity. Results The majority of patients had mild or no pain at 6 months, and minimal pain-related impairment, but approximately 30% reported pain intensity ratings of 3/10 or higher. Reporting greater pain severity and dysfunction at 6 months post-TKA was predicted by higher preoperative levels of negative affect, prior pain history, opioid use, and disrupted sleep. Interestingly, lower levels of resilience-related “positive” psychosocial characteristics (i.e., lower agreeableness, lower social support) were among the strongest, most consistent predictors of poor outcomes in multivariable linear regression models. Maladaptive profiles of pain modulation (e.g., elevated temporal summation of pain), while not robust unique predictors, interacted with psychosocial risk factors such that the TKA ...

الإتاحة: https://doi.org/10.1186/s12891-022-05239-3Test

المؤلفون: Leyland, Kirsten M., Gates, Lucy S., Sanchez-Santos, Maria T., Nevitt, Michael C., Felson, David, Jones, Graeme, Jordan, Joanne M., Judge, Andrew, Prieto-Alhambra, Dani, Yoshimura, Noriko, Newton, Julia L., Callahan, Leigh F., Cooper, Cyrus, Batt, Mark E., Lin, Jianhao, Liu, Qiang, Cleveland, Rebecca J., Collins, Gary S., Arden, Nigel K., March, Lyn, Hawker, Gillian, Conaghan, Philip, Kraus, Virginia Byers, Guermazi, Ali, Hunter, David, Katz, Jeffrey N., McAlindon, Tim, Neogi, Tuhina, Simon, Lee, Cross, Marita, King, Lauren

المساهمون: Versus Arthritis, University of Oxford

المصدر: Aging Clinical and Experimental Research ; volume 33, issue 3, page 529-545 ; ISSN 1720-8319

مصطلحات موضوعية: Geriatrics and Gerontology, Aging

الوصف: Background Osteoarthritis (OA) is a chronic joint disease, with increasing global burden of disability and healthcare utilisation. Recent meta-analyses have shown a range of effects of OA on mortality, reflecting different OA definitions and study methods. We seek to overcome limitations introduced when using aggregate results by gathering individual participant-level data (IPD) from international observational studies and standardising methods to determine the association of knee OA with mortality in the general population. Methods Seven community-based cohorts were identified containing knee OA-related pain, radiographs, and time-to-mortality, six of which were available for analysis. A two-stage IPD meta-analysis framework was applied: (1) Cox proportional hazard models assessed time-to-mortality of participants with radiographic OA (ROA), OA-related pain (POA), and a combination of pain and ROA (PROA) against pain and ROA-free participants; (2) hazard ratios (HR) were then pooled using the Hartung–Knapp modification for random-effects meta-analysis. Findings 10,723 participants in six cohorts from four countries were included in the analyses. Multivariable models (adjusting for age, sex, race, BMI, smoking, alcohol consumption, cardiovascular disease, and diabetes) showed a pooled HR, compared to pain and ROA-free participants, of 1.03 (0.83, 1.28) for ROA, 1.35 (1.12, 1.63) for POA, and 1.37 (1.22, 1.54) for PROA. Discussion Participants with POA or PROA had a 35–37% increased association with reduced time-to-mortality, independent of confounders. ROA showed no association with mortality, suggesting that OA-related knee pain may be driving the association with time-to-mortality. Funding Versus Arthritis Centre for Sport, Exercise and Osteoarthritis and Osteoarthritis Research Society International.

الإتاحة: https://doi.org/10.1007/s40520-020-01762-2Test

المؤلفون: Williams, Emma E., Arant, Kaetlyn R., Leifer, Valia P., Balcom, Mardi Chadwick, Levy-Carrick, Nomi C., Lewis-O’Connor, Annie, Katz, Jeffrey N.

المصدر: BMC Women's Health ; volume 21, issue 1 ; ISSN 1472-6874

مصطلحات موضوعية: Obstetrics and Gynecology, Reproductive Medicine, General Medicine

الوصف: Background Early research suggests the COVID-19 pandemic worsened intimate partner violence (IPV) in the US. In particular, stay-at-home orders and social distancing kept survivors in close proximity to their abusers and restricted access to resources and care. We aimed to understand and characterize the impact of the pandemic on delivery of IPV care in Boston. Methods We conducted individual interviews with providers of IPV care and support in the Greater Boston area, including healthcare workers, social workers, lawyers, advocates, and housing specialists, who continued to work during the COVID-19 pandemic. Using thematic analysis, we identified themes describing the challenges and opportunites providers faced in caring for survivors during the pandemic. Results Analysis of 18 interviews yielded four thematic domains, encompassing 18 themes and nine sub-themes. Thematic analysis revealed that the pandemic posed an increased threat to survivors of IPV by exacerbating external stressors and leading to heightened violence. On a system level, the pandemic led to widespread uncertainty, strained resources, amplified inequities, and loss of community. On an individual level, COVID-19 restrictions limited survivors’ abilities to access resources and to be safe, and amplified pre-existing inequities, such as limited technology access. Those who did not speak English or were immigrants experienced even more difficulty accessing resources due to language and/or cultural barriers. To address these challenges, providers utilized video and telephone interactions, and stressed the importance of creativity and cooperation across different sectors of care. Conclusions While virtual care was essential in allowing providers to care for survivors, and also allowed for increased flexibility, it was not a panacea. Many survivors faced additional obstacles to care, such as language barriers, unequal access to technology, lack of childcare, and economic insecurity. Providers addressed these barriers by tailoring services ...

الإتاحة: https://doi.org/10.1186/s12905-021-01460-9Test

المؤلفون: Malone, Nelson C., Williams, Mollie M., Smith Fawzi, Mary C., Bennet, Jennifer, Hill, Caterina, Katz, Jeffrey N., Oriol, Nancy E.

المساهمون: Boeing, Harvard University Interfaculty Provost, Ronald McDonald House Charities, U.S. Department of Health and Human Services, Aetna Foundation

المصدر: International Journal for Equity in Health ; volume 19, issue 1 ; ISSN 1475-9276

مصطلحات موضوعية: Public Health, Environmental and Occupational Health, Health Policy

الوصف: Background Mobile health clinics serve an important role in the health care system, providing care to some of the most vulnerable populations. Mobile Health Map is the only comprehensive database of mobile clinics in the United States. Members of this collaborative research network and learning community supply information about their location, services, target populations, and costs. They also have access to tools to measure, improve, and communicate their impact. Methods We analyzed data from 811 clinics that participated in Mobile Health Map between 2007 and 2017 to describe the demographics of the clients these clinics serve, the services they provide, and mobile clinics’ affiliated institutions and funding sources. Results Mobile clinics provide a median number of 3491 visits annually. More than half of their clients are women (55%) and racial/ethnic minorities (59%). Of the 146 clinics that reported insurance data, 41% of clients were uninsured while 44% had some form of public insurance. The most common service models were primary care (41%) and prevention (47%). With regards to organizational affiliations, they vary from independent (33%) to university affiliated (24%), while some (29%) are part of a hospital or health care system. Most mobile clinics receive some financial support from philanthropy (52%), while slightly less than half (45%) receive federal funds. Conclusion Mobile health care delivery is an innovative model of health services delivery that provides a wide variety of services to vulnerable populations. The clinics vary in service mix, patient demographics, and relationships with the fixed health system. Although access to care has increased in recent years through the Affordable Care Act, barriers continue to persist, particularly among populations living in resource-limited areas. Mobile clinics can improve access by serving as a vital link between the community and clinical facilities. Additional work is needed to advance availability of this important resource.

الإتاحة: https://doi.org/10.1186/s12939-020-1135-7Test

المؤلفون: Pereira, Joseph A., Hannibal, Kari, Stecker, Jasmine, Kasper, Jennifer, Katz, Jeffrey N., Molina, Rose L.

المساهمون: Harvard Medical School’s Scholars in Medicine Office

المصدر: BMC Medical Education ; volume 20, issue 1 ; ISSN 1472-6920

مصطلحات موضوعية: Education, General Medicine

الوصف: Background Despite the growing number of patients with limited English proficiency in the United States, not all medical schools offer medical language courses to train future physicians in practicing language-concordant care. Little is known about the long-term use of non-English languages among physicians who took language courses in medical school. We conducted a cross-sectional study to characterize the professional language use of Harvard Medical School (HMS) alumni who took a medical language course at HMS and identify opportunities to improve the HMS Medical Language Program. Methods Between October and November 2019, we sent an electronic survey to 803 HMS alumni who took a medical language course at HMS between 1991 and 2019 and collected responses. The survey had questions about the language courses and language use in the professional setting. We analyzed the data using descriptive statistics and McNemar’s test for comparing proportions with paired data. The study was determined not to constitute human subjects research. Results The response rate was 26% (206/803). More than half of respondents ( n = 118, 57%) cited their desire to use the language in their future careers as the motivation for taking the language courses. Twenty-eight (14%) respondents indicated a change from not proficient before taking the course to proficient at the time of survey whereas only one (0.5%) respondent changed from proficient to not proficient (McNemar’s p -value < 0.0001). Respondents ( n = 113, 56%) reported that clinical electives abroad influenced their cultural understanding of the local in-country population and their language proficiency. Only 13% ( n = 27) of respondents have worked in a setting that required formal assessments of non-English language proficiency. Conclusions HMS alumni of the Medical Language Program reported improved language proficiency after the medical language courses’ conclusion, suggesting that the courses may catalyze long-term language learning. We found that a majority of ...

الإتاحة: https://doi.org/10.1186/s12909-020-02323-xTest

المؤلفون: Safran-Norton, Clare E., Sullivan, James K., Irrgang, James J., Kerman, Hannah M., Bennell, Kim L., Calabrese, Gary, Dechaves, Leigh, Deluca, Brian, Gil, Alexandra B., Kale, Madhuri, Luc-Harkey, Brittney, Selzer, Faith, Sople, Derek, Tonsoline, Peter, Losina, Elena, Katz, Jeffrey N.

المساهمون: National Institute of Arthritis and Musculoskeletal and Skin Diseases

المصدر: BMC Musculoskeletal Disorders ; volume 20, issue 1 ; ISSN 1471-2474

مصطلحات موضوعية: Orthopedics and Sports Medicine, Rheumatology

الوصف: Background Knee osteoarthritis (OA) is prevalent and often associated with meniscal tear. Physical therapy (PT) and exercise regimens are often used to treat OA or meniscal tear, but, to date, few programs have been designed specifically for conservative treatment of meniscal tear with concomitant knee OA. Clinical care and research would be enhanced by a standardized, evidence–based, conservative treatment program and the ability to study the effects of the contextual factors associated with interventions for patients with painful, degenerative meniscal tears in the setting of OA. This paper describes the process of developing both a PT intervention and a home exercise program for a randomized controlled clinical trial that will compare the effectiveness of these interventions for patients with knee pain, meniscal tear and concomitant OA. Methods This paper describes the process utilized by an interdisciplinary team of physical therapists, physicians, and researchers to develop and refine a standardized in-clinic PT intervention, and a standardized home exercise program to be carried out without PT supervision. The process was guided in part by Medical Research Council guidance on intervention development. Results The investigators achieved agreement on an in-clinic PT intervention that included manual therapy, stretching, strengthening, and neuromuscular functional training addressing major impairments in range of motion, musculotendinous length, muscle strength and neuromotor control in the major muscle groups associated with improving knee function. The investigators additionally achieved agreement on a progressive, protocol-based home exercise program (HEP) that addressed the same major muscle groups. The HEP was designed to allow patients to perform and progress the exercises without PT supervision, utilizing minimal equipment and a variety of methods for instruction. Discussion This multi-faceted in-clinic PT program and standardized HEP provide templates for in-clinic and home-based care for ...

الإتاحة: https://doi.org/10.1186/s12891-019-2872-xTest

المؤلفون: Alves, Kristin, Penny, Norgrove, Ekure, John, Olupot, Robert, Kobusingye, Olive, Katz, Jeffrey N., Sabatini, Coleen S.

المساهمون: National Institutes of Health

المصدر: BMC Musculoskeletal Disorders ; volume 19, issue 1 ; ISSN 1471-2474

مصطلحات موضوعية: Orthopedics and Sports Medicine, Rheumatology

الإتاحة: https://doi.org/10.1186/s12891-018-2254-9Test