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The Women in Behavior Analysis Hall of Fame was created to identify and honor outstanding women who have contributed to the field. Six stellar and impactful women were inducted into the 2022 class: Ellen Reese, Barbara Etzel, Beth Sulzer-Azaroff, Frances Horowitz, Julie Vargas, and Gwendolyn Cartledge. This paper provides details on the individual accomplishments, accolades, and impacts of these women, as described during the Hall of Fame induction ceremony.
The Spotlight on Nursing is a recurring column from the University of Hawai'i at Mānoa School of Nursing and Dental Hygiene (SONDH). It is edited by Holly B. Fontenot, PhD, APRN, WHNP-BC, FAAN, FNAP; Associate Dean for Research, Professor, and Frances A. Matsuda Chair in Women's Health for SONDH, and HJH&SW Contributing Editor; and Joanne R. Loos PhD, Science Writer for SONDH. Hawai'i is experiencing the effects of climate change, including increased temperatures, decreased rainfall, and higher frequency of extreme weather. In 2023, the Climate Change and Health Working Group (CCHWG) was formed, bringing together over 250 public health professionals dedicated to catalyzing community action by adopting a health-oriented approach to challenges posed by climate change. To date, members have engaged in crafting public policy initiatives to embed health perspectives into statewide legislation on climate change issues and created community listening sessions aimed at matching resources to the needs of underserved communities. The CCHWG's actions are charting a roadmap to guide collaborative efforts between health professionals and communities aimed at mitigating the health impacts of climate change and bolstering resilience. Future goals include expanding efforts across the state and to other populations across the Pacific to implement similar community-driven transformative change.
Every minute, a family member begins their "caregiving career" with the primary responsibility of caring for someone with dementia. Their career may progress through in-home caregiving (i.e. caregivers), to partnering with a facility (i.e. care partners), to caretaking after bereavement (i.e. caretakers). Although each phase presents challenges that adversely affect one's health, responses to such challenges (i.e. stress, cognitions, and emotions) and strategies to manage them (i.e. resourcefulness) may vary across the career trajectory. Resourcefulness Theory© informed this preliminary analysis of baseline data from a randomized trial with 145 caregivers, 111 care partners, and 62 caretakers of persons with dementia recruited from the community and online. The three groups were compared on measures of stress, depressive cognitions, negative emotions, and resourcefulness (personal, social, and spiritual) using one-way analysis of variance. The three groups reported similar stress (F = 0.986; p = 0.374), depressive cognitions (F = 0.184; p = 0.832), and negative emotions (F = 0.123; p = 0.884). Mean scores indicated moderate stress (M = 20.08; SD = 7.21), moderate risk for depression (M = 9.23; SD = 6.83), and substantial negative emotions (M = 6.80; SD = 2.81). Resourcefulness scores for all three groups indicated a moderate need for resourcefulness training, however, they differed (personal: F = 2.94; p = 0.027; social: F = 2.44; p = 0.045; spiritual: F = 4.00; p = 0.010) with caretakers scoring lowest. The findings indicated that across the "caregiving career," there were similar responses to caregiving challenges regardless of caregiving phase. Future research should identify contextual factors associated with those responses. Although resourcefulness scores indicated all three groups would benefit from resourcefulness training, bereaved caretakers showed the greatest need, suggesting the importance of teaching them resourcefulness skills.
Judith Schneider Stern, Distinguished Professor Emerita of Nutrition and Internal Medicine at University of California at Davis, died on 8 May, 2019 after a distinguished career in studying, teaching, and communicating about obesity.
Immune checkpoint inhibitors (ICIs) have revolutionized the management of advanced melanoma. SWOG S1801 demonstrated improved event-free survival (EFS) with neoadjuvant pembrolizumab compared with adjuvant therapy alone in resectable stage III/IV melanoma patients. Similarly, the NADINA trial demonstrated improved EFS by using neoadjuvant ipilimumab plus nivolumab compared to adjuvant nivolumab. We conducted a retrospective study to evaluate outcomes associated with neoadjuvant versus adjuvant ICI in real-world patients with stage III/IV melanoma. We reviewed records from our prospectively-maintained IRB-approved institutional database from January 2020 to December 2024 to identify consented patients with clinically detectable stage IIIB to IIID or oligometastatic stage IVA to IVC melanoma who had intended curative-intent surgery and received ICI preoperatively (neoadjuvant) and postoperatively (adjuvant) or only adjuvantly. The patients had to have at least 12 months of follow-up or an event to be included. The primary endpoint was EFS, defined as time from diagnosis of stage III or IV melanoma to recurrence, progression, or death. Secondary endpoints included pathological response in the neoadjuvant group. A total of 159 patients met the inclusion criteria: 102 received neoadjuvant ICI, and 57 received only adjuvant ICI. In a landmark analysis, EFS at 1 year was 79.2% (95% confidence interval [CI] 71.6-87.5) in the neoadjuvant group and 54.7% (95% CI 43.2-69.3) in the adjuvant-only group. The EFS at 2 years was 68.9% (95% CI 59.9-79.2) in the neoadjuvant group and 46.3% (95% CI 34.7-61.8) in the adjuvant only group (p = 0.05). The median follow-up was 28.7 months (IQR 18.5-41.3) in the neoadjuvant group and 30.1 months (IQR 19.5-41.8) in the adjuvant group. Major pathologic response was observed in 56 (54.9%) patients, partial pathologic response in 11 (10.8%), no response in 23 (22.5%), and progression in 12 (11.8%) patients treated with neoadjuvant ICI. In this single-academic institution analysis, neoadjuvant ICI was associated with improved 2-year EFS compared with adjuvant ICI in patients with advanced melanoma, consistent with prospective data from SWOG 1801 and NADINA. This evidence validated the integration of neoadjuvant ICI therapy into clinical practice and underscores the importance of real-world validation.
Understanding the recovery trajectory of functional disability in older adults with cognitive impairment can enhance perioperative care through early identification of at-risk patients, risk stratification, and proactive post-discharge planning. This multicenter longitudinal study compared the prevalence and trajectory of functional disability preoperatively and at 30, 90, and 180 days postoperatively between 307 older non-cardiac surgical participants with and without probable cognitive impairment, and examined their incidence of adverse postoperative outcomes. Online and telephone assessments were administered to assess cognition and functional disability. Cognition was assessed using the Ascertain Dementia Eight-item Questionnaire (AD8), with a preoperative score ≥2 classifying probable cognitive impairment. Functional disability was self-reported preoperatively and at 30, 90, and 180 days postoperatively using the 12-item World Health Organization Disability Assessment Schedule 2.0, with scores ≥ 16% indicating functional disability exceeding a patient-acceptable symptom state. Of 307 participants, 17% screened positive for probable cognitive impairment using the AD8 preoperatively. Participants with probable cognitive impairment had a significantly higher perioperative prevalence of functional disability than those without. Nevertheless, probable cognitive impairment did not modify the recovery pattern of functional disability. Additionally, probable cognitive impairment was associated with greater postoperative delirium (OR: 7.37 [95% CI 2.25, 25.97], P = 0.001) and 180-day emergency department visits (OR: 5.05 [95% CI 1.34, 18.92], P = 0.014) after age adjustment. A positive AD8 screen was associated with greater perioperative functional disability and adverse clinical outcomes. Despite this heightened risk, we did not find evidence that probable cognitive impairment modified the recovery trajectory of functional disability. Our exploratory study suggests that the AD8 may be useful in guiding patient-centered preoperative discussions and identifying patients with probable cognitive impairment who may warrant closer perioperative monitoring.
The World Health Organization highlights significant disparities in access to palliative care (PC), especially in primary and community care. In France, ASALEE is an innovative national association that brings nurses and general practitioners in primary and community care. Initially created to address the support needs of patients living with chronic diseases, the nurses' roles have expanded to include PC. However, despite the growing role of such interprofessional models, research on PC nurses' activities and skills in primary and community care are underdeveloped. To identify, categorize, compare PC models in primary and community care and analyze them through nursing skills and activities, using the ASALEE PC link-nurses' specific role as a comparator. A narrative literature review on studies published between 2017 and 2024 was performed. PC models were categorized using the Understanding Integrated Care Conceptual Framework. Extracted data on nursing activities and skills in PC were compared with those developed by ASALEE's PC Support Group. This group is working on the integration of PC for patients in primary and community care. Twenty-one studies were selected. Searching on micro, meso, and macro levels, the review identified six key models of PC in primary and community care: integrative PC, health promotion-, community-, professional skills-, patient-centered, and end-of-life process-focused. These models emphasize inter-professional collaboration, informal caregivers' involvement, community engagement, and patient partnership in PC support. The review provides insights into PC nurses' activities and skills in primary and community care, particularly in terms of interpersonal relationships. The review is limited by heterogeneous study designs and contexts, which constrain generalizability, but, while partially transferable to the French healthcare system, these models require adaptations to be fully integrated. This review proposes perspectives for PC integration, future research, and to enhance ASALEE PC link-nurses' practice and strengthen their collaboration with physicians, informal caregivers, and patients, in France and at the international level. This review identifies PC models, core nursing skills and activities, and collaborative practices that can guide future PC nurses in primary and community care, by proposing changes for their implementation. The World Health Organization notes many people lack access to palliative care, especially in community settings. In France, ASALEE is a program where nurses and family doctors work together in local health centers to support patients. While ASALEE nurses now help with palliative care, we need clearer understanding of their specific roles and skills.We reviewed 21 studies (2017-2024) on palliative care nursing models in primary and community care. We found six main approaches, all emphasizing teamwork between healthcare professionals, involving families and communities, and focusing on patients’ individual needs and life goals. These models show how nurses can effectively provide palliative care through activities like symptom management, emotional support, care coordination, and helping patients make informed decisions.While these models offer valuable insights, they need adaptation to fit different healthcare systems like France’s. This research helps identify how programs like ASALEE can better integrate palliative care into everyday community health services by clarifying the essential skills, activities, and collaborative practices nurses need to support patients with serious illnesses near the end of life.
Resourcefulness is the capacity to confront life's obstacles by utilizing coping skills, adapting to new circumstances, and seeking assistance from the environment. Therefore, the geriatric field continues to emphasize the importance of older adults' resourcefulness. The Indonesian version of the Resourcefulness Scale© (I-RS) has just been translated; it is essential to conduct this research and report the findings for its application in Indonesia. This study intended to develop the Bahasa Indonesian version of the Resourcefulness Scale© and to test its reliability and validity in older adults. The questionnaire was initially created in English and then translated by two linguistic experts. Subsequently, meaning and cultural analysis were performed by psychiatric nursing specialists. Following this, a back-translation was executed, and the Indonesian version was used for data collection. Data was collected with 331 older adults residing in 11 nursing homes from 2023 to 2024. Correlational analysis and Confirmatory Factor Analysis (CFA) were conducted using Structural Equation Modeling (SEM) in LISREL 8.8 to examine the validity of the I-RS. Reliability was assessed using Cronbach's Alpha and Split-half reliability. The internal consistency of the Indonesian version of the instrument is acceptable with Cronbach's Alpha .79 and Split-half reliability .75. According to the results of SEM, Chi square = 253.13, the Root means square error of approximation (RMSEA = 0.04), the adjusted goodness of fit index (AGFI = 0.90), Normed Fit Index (NFI = 0.92), Parsimony Normed Fit Index (PNFI = 0.76) and Comparative fit Index (CFI = 0.97) were all accepted. Two factors, such as personal and social resourcefulness, were identified through factor analysis using SEM. A positive and significant relationship was found between resourcefulness and spiritual health (r = 0.45, p < 0.001). These results confirmed the use of the Indonesian version of the Resourcefulness scale (I-RS), indicating that it has acceptable reliability and validity. This instrument is potentially useful for measuring older adults' resourcefulness in geriatric nursing in Indonesia, across both clinical and community settings.
While there is evidence of the benefits of healthy maternal lifestyle behaviors (eg, physical activity plus a healthy diet) on cardiometabolic health, there are limited data on the independent association between physical activity and cardiometabolic health among women with a history of gestational diabetes mellitus (GDM). In this study, our aim was to explore the association between device-assessed physical activity and cardiometabolic outcomes in Chinese American women, a group disproportionately affected by GDM and type 2 diabetes. A cross-sectional study was conducted among 33 Chinese American women (0.5-5 years after delivery) with a history of GDM in New York City in 2023 to 2024, in which we collected their device-assessed physical activity data, online survey data (in Mandarin and English), and cardiometabolic data (via fasting blood samples). Descriptive, unadjusted, and adjusted regression analyses were performed. Participants' mean age was 38.2 ± 3.3 years (2.6 ± 1.5 years after delivery), and body mass index was 23.5 (interquartile range: 21.7-25.1) kg/m 2 . Among the 33 participants, 27.3% had prediabetes, 51.5% had lipid dysregulation, and 21.2% had elevated blood pressure. The duration of moderate-to-vigorous physical activity per week was 132.4 (interquartile range: 90.5-272.0) minutes, and 46.9% of the cohort met the physical activity recommendation of ≥150 minutes moderate-to-vigorous physical activity per week. In regression models, meeting the physical activity recommendations was inversely associated with total cholesterol (-27.6 ± 12.7 mg/dL) and low-density lipoprotein cholesterol (-25.5 ± 10.6 mg/dL) levels (both P <.04). The majority of participants engaged in suboptimal physical activity levels. However, meeting physical activity recommendations was associated with better total and low-density lipoprotein cholesterol levels. Targeting physical activity may be a key strategy for improving cardiometabolic health in Chinese American women recently diagnosed with GDM.
Gastrointestinal (GI) cancer care requires coordination across specialties and is sensitive to non-medical barriers like insurance, transportation, and health literacy. Prior survey work at our institution identified these barriers as most prominent during initial treatment planning and as consuming substantial provider time. This qualitative study represents the second phase of a larger effort to inform the development of a transdisciplinary care model designed to address non-medical determinants of care. We conducted semi-structured interviews with purposively sampled multidisciplinary providers involved in GI cancer care at a large academic health system in the USA. Interviews explored patient- and system-level barriers and opportunities to improve care coordination. Transcripts underwent inductive thematic analysis with double coding. Pearson correlation coefficients assessed covariation among themes and informed the construction of a directed acyclic graph illustrating hypothesized causal relationships among barrier domains. We interviewed 30 providers, including physicians (n = 7), advanced practice providers (n = 2), nurses (n = 5), dietitians (n = 7), social workers (n = 6), and a care coordinator (n = 1). Seven interconnected themes emerged: health system, financial, access and logistics, provider capacity, patient knowledge and engagement, social and emotional, and communication and coordination. Structural and financial barriers operated as upstream drivers influencing workflow and access, while logistical and social barriers translated these pressures into downstream inefficiencies and provider strain. Providers consistently supported a transdisciplinary care model to centralize navigation and support. Non-medical barriers in GI cancer care undermine patient care, provider capacity, and health system efficiency. These findings provide an actionable framework for developing equitable, efficient, and sustainable cancer care models.
Cognitive impairment is common among older adults and is associated with adverse outcomes such as prolonged hospital stays and increased mortality. Many of the medical inpatients subsequently undergo surgical procedures, where cognitive impairment is known to influence perioperative risk, anesthetic management, and postoperative outcomes. No meta-analysis has comprehensively synthesized global data specific to cognitive impairment among medically hospitalized patients. We aimed to determine the global prevalence of cognitive impairment in older medical inpatients and explore variations by assessment method and region. We searched MEDLINE (Ovid), Embase, Cochrane Central, Cochrane Database of Systematic Reviews, and PsycINFO for relevant articles. We included patients ≥ 60 years old admitted to hospitals and studies examining prevalence of cognitive impairment. Excluded were elective surgical patients and non-hospital settings. Cognition was assessed by validated cognitive assessment tools, diagnostic instruments, or prior diagnosis. The primary outcome was the pooled prevalence of cognitive impairment in older patients admitted to hospitals. Subgroup analyses were conducted based on cognitive assessment tools, geographic regions, study type, and sample size. Fifty-six studies (n = 62,853) were included. Mean age was 79.8 ± 7.7 years with 56% female. Meta-analysis revealed substantial variability across studies, with pooled prevalence estimates demonstrating high heterogeneity. The prevalence of newly suspected cognitive impairment/dementia using the Diagnostic and Statistical Manual of Mental Disorders and/or validated screening tools was 38% (95% CI: 33%-42%). The prevalence of pre-diagnosed cognitive impairment/dementia documented from medical records was 24% (95% CI: 19%-29%). The prevalence of dementia was higher in Western countries than Eastern countries [41% (95% CI: 32%-50%) vs 27% (95% CI: 21%-33%)]. Cognitive impairment is prevalent among older medical inpatients. The variability in prevalence was dependent on assessment method and geographic region. Given the substantial heterogeneity and low to very low certainty of the evidence available, these prevalence estimates should be interpreted with caution.
To estimate the prevalence of polypharmacy among older adults with incident epilepsy and to describe the most common combinations of drug classes filled prior to epilepsy diagnosis. Polypharmacy-the concurrent use of multiple medications-is common in older adults with epilepsy, but little is known about its burden and specific patterns at the time of diagnosis. This retrospective longitudinal cohort study included 2 768 656 US Medicare beneficiaries aged 67 and older with Part D coverage. Beneficiaries were epilepsy-free from 2016 to 2018; 13 819 (0.5%) were newly diagnosed with epilepsy in 2019. The prevalence of polypharmacy and combinations of therapeutic drug classes filled in 2018 were compared between those with and without incident epilepsy using frequent itemset mining and regression models to estimate adjusted rate ratios. Beneficiaries with incident epilepsy filled prescriptions for a greater number of therapeutic drug classes in the year prior to diagnosis compared with those without epilepsy (median 9 [IQR 5-12] vs. 6 [IQR 3-9]) and were more likely to have filled prescriptions for five or more distinct drug classes (81.4% vs. 63.3%). Antidepressants, gastric medications, and loop diuretics were more prevalent among beneficiaries with incident epilepsy. The combination of calcium channel blockers and antihypertensives was most strongly associated with incident epilepsy after adjustment (adjusted rate ratio 1.54 [99% CI, 1.38-1.71]). Older adults with incident epilepsy experience a high burden of polypharmacy at the time of diagnosis, with nearly 90% prescribed five or more drug classes. Certain drug class combinations, such as antipsychotics and antidepressants, were more frequently observed among those with incident epilepsy. These findings underscore the importance of considering overall polypharmacy burden and specific drug class combinations when initiating epilepsy therapy in older adults. Older adults who develop epilepsy often take many medications for other health conditions. In this study of US Medicare beneficiaries, people who were later diagnosed with epilepsy were taking about nine different types of drug classes in the year before diagnosis, compared with about six drug classes among those who did not develop epilepsy. Certain combinations of drug classes-especially those affecting the brain and nervous system-were more common among people who developed epilepsy. These findings show that many older adults have complex medication regimens when epilepsy is first diagnosed.
Amyotrophic lateral sclerosis (ALS) is a rare, progressive neurodegenerative disorder, with a substantial proportion of cases attributed to genetic factors. Recent advances in gene discovery and genomic technologies have transformed ALS care by enabling genomic testing to inform prognosis, assess familial risk, and facilitate access to novel therapies. However, guidance on the delivery of genetic testing and counselling in ALS remains limited, leading to variability in clinical practice. In response, the Manchester Motor Neuron Disease (MND) Care Centre and the Manchester Centre for Genomic Medicine co-developed a structured genetic care pathway for ALS, drawing on real-world data, patient engagement, and multidisciplinary collaboration. A retrospective evaluation of 326 ALS patients at the Manchester MND Care Centre identified significant variability in genetic testing uptake, counselling practices, and record-keeping. Patient survey and engagement sessions revealed uncertainty regarding key genetic concepts and inconsistent recall of pre- and post-test discussions. Priorities for improvement included clearer communication, standardised discussions, and enhanced support for families following genetic findings. Consequently, the Greater Manchester ALS Genetic Testing Pathway was developed by a multidisciplinary team, incorporating consensus-based steps for patient identification, pre-test conversations, consent, testing, results disclosure, and post-test support. This pathway integrates genetic testing into routine ALS care, clarifies team responsibilities, and establishes a framework for ongoing evaluation using key performance indicators. Patient and staff feedback is used to support continuous improvement. The co-developed ALS genetic testing pathway provides a scalable model for standardising genomic care in mainstream clinical settings. By establishing clear processes for genetics discussions, consent, and follow-up, the pathway seeks to improve equity, transparency, and person-centred care. Ongoing evaluation and collaboration with patients, clinicians, and genetic services are essential to ensure the pathway remains responsive to scientific advances and evolving patient needs. Wider adoption of structured genetic pathways may facilitate the integration of genomics into care for rare diseases across healthcare systems.
In multiple sclerosis (MS), optical coherence tomography (OCT) is used to quantify retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thinning; however, thickness metrics may not capture microstructural alterations within the synapse-rich inner plexiform layer (IPL). The purpose of this study is to determine whether IPL microstructure differs in MS, whether abnormalities occur independently of optic neuritis and inner retinal thinning, and whether IPL metrics improve discrimination beyond thickness metrics. Cross-sectional case-control study (49 MS [92 eyes], 59 controls [109 eyes]). IPL reflectivity was quantified from OCT. Mixed-effects models included RNFL/GCC adjustment; receiver operating characteristic curve assessed discrimination. The percentage of IPL segments with an identifiable five-sublayer pattern was lower in MS (-20 percentage points; 95% confidence interval [CI], -25 to -13). MS eyes demonstrated higher outer hyporeflective sublayer intensity (0.15; 95% CI, 0.09 to 0.21) and lower middle hyperreflective-outer hyporeflective contrast (-0.13; 95% CI, -0.19 to -0.08). Findings persisted in non-optic neuritis eyes and after RNFL/GCC adjustment. The percentage of identifiable IPL segments discriminated MS from controls (area under the curve, 0.81; 95% CI, 0.73-0.90) exceeding RNFL/GCC. IPL microstructure was altered in MS independent of optic neuritis and inner retinal thinning. Quantitative assessment of IPL microstructure may provide complementary structural information in MS.
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Amphibians in agricultural drainage ditches may be exposed to contaminants through runoff and subsurface drainage, which can result in toxicity. Understanding the agroecosystem management activities that can sustain healthy amphibian populations will support biodiversity and ecosystem services within intensive agricultural areas. This study examined how woody vegetation within agricultural areas is associated with water quality and amphibian health metrics. Cages containing northern leopard frog (Lithobates [Rana] pipiens) tadpoles were placed within nine agricultural ditches differing in their riparian vegetation height and percentage of surrounding forest cover for eight weeks (May-July) in an agriculturally dominated watershed in eastern Canada. Physicochemical water quality measurements and pesticide concentrations indicated that sites higher in percent forest cover (within 1 km radius) had lower specific conductance, atrazine, nitrate, and potassium concentrations. Percent forest cover was positively associated with tadpole growth (snout-to-vent length, tail length, mass) and riparian vegetation height positively related to tadpole development. Furthermore, glucose levels increased with forest cover, while corticosterone and hepatosomatic index remained unchanged, suggesting that elevated glucose was not strongly associated with chronic stress in this study. Finally, tested tadpoles were negative for Batrachochytrium dendrobatidis, B. salamandrivorans and Frog Virus 3, suggesting these pathogens are not currently a threat to these organisms at the sites tested. Collectively, our findings suggest forested habitats within intensive agroecosystems are critical landscape elements for reducing agrochemical exposure and improving tadpole health in drainage ditches, whereas woody riparian buffers provide limited additional benefits for aquatic stages, highlighting the importance of considering life-stage-specific responses.
Transgender and gender diverse (TGD) youth face significant health disparities, underscoring the critical need for equitable, evidence-based care. Based on substantial evidence, the gender-affirming care model remains the standard of care. TGD youth may seek gynecologic expertize for a variety of reproductive health care concerns. This article outlines essential considerations for clinicians when providing gender-inclusive services to pediatric patients. Key areas addressed include creating a safe clinical environment, managing psychosocial comorbidities, administering gender affirming medical therapy, and addressing gynecologic needs such as menstrual suppression, contraception, sexual health screening, and fertility counseling.
Chronic liver disease (CLD) is a high morbidity and mortality condition with a high incidence/prevalence worldwide. Despite the diverse etiological factors involved, common pathogenic hallmarks in CLD progression are the accumulation of scarring hepatic tissue and a sustained local and systemic inflammatory response. Considering the constant exposure of the liver to antigens and the delicate homeostatic immune surveillance that takes place in the organ, hepatic antigen presenting cells (hAPCs; i.e. Kupffer Cells, Liver Sinusoidal Endothelial Cells and Dendritic Cells) and their activity regulation are key players in the maintenance of intrahepatic immune tolerance. Epigenetic regulation is considered as a relevant mechanism in several stages of CLD development, currently recognized for playing a pivotal role in hepatic stellate cells activation in liver fibrosis as well as tumor suppressor gene silencing and tumoral microenvironment immune-escape. However, influence of epigenetic mechanisms over immune response in CLD continues under study. Here we comprehensively review the main epigenetic regulatory mechanisms controlling hAPCs regulation, considering the intricate crosstalk of epigenetic effectors and discussing recent studies supporting epigenetic interventions with promising therapeutical potential over inflammatory response during CLD progression.
Acute and chronic subdural haematomas are two common but distinct conditions, increasingly encountered by non-neurosurgical medical teams. Although each carries a significant mortality, there have been recent advances in the care of these, typically in older, frail patients. Challenges often arise from cardiovascular or thrombotic disease and with the need for antithrombotic medication. When considering when or whether to restart antithrombotic agents, patients need nuanced, individualised decisions to balance the competing risks of thrombosis against that of progressive or recurrent haemorrhage. Middle meningeal artery embolisation is increasingly used both as an adjunctive intervention and a stand-alone treatment for chronic subdural haematoma. The evidence defining its role is evolving but it appears safe and effective and will likely be increasingly used.