Reflections of Moral Suffering,Resilience, and Wisdom of Pediatric Oncology Social Workers during the COVID-19 Pandemic

Background: The COVID-19 pandemic has significantly altered the lives of pediatric oncology social workers. Challenges include difficulty building rapport with the use of telephone/computers, lack of clarity around who is designated as “essential”, structural challenges, isolation, and witnessing distress. This study aimed to describe the ways that the pandemic has personally impacted pediatric oncology social workers. Methods: Participants were recruited through the Association of Pediatric Oncology Social Workers (APOSW) listserv. In total, 101 participants from 31 states and the District of Columbia completed an online survey containing quantitative and open-ended questions. Qualitative data analysis included thematic analysis of participants’ optional survey responses to three open-ended questions. Results: Fifty-seven of the participants provided responses that revealed 3 first level codes and 11 second level codes. First level codes were developed a priori from the questions: Experiences that stay with you, Wisdom gained and Impact on your work. Pandemic-related challenges caused moral suffering and professional challenges for participants but also created opportunities to find meaning in their work. Conclusion: Data illuminated moral suffering, unrecognized resilience, new ways of maintaining self-and family care, and creative approaches to care of children with cancer and their families at diagnosis, during treatments and at the end of life.     

Successful allogeneic transplantation of patients with suspected prior invasive mold infection

Prior invasive fungal infection (IFI) has historically limited the use of allogeneic stem cell transplantation for patients with hematologic malignancies. Transplantation of such patients frequently resulted in recurrent infection and high mortality rates. Several new antifungal agents have been introduced over the past 5 years with broader spectra of activity against molds such as Aspergillus and a favorable toxicity profile. In this study, we present a series of 16 consecutive patients with hematologic malignancy and prior invasive fungal infection who underwent allogeneic transplantation. Of these patients, the majority of whom were treated with voriconazole and/or caspofungin, only four experienced recurrent fungal infection and recurrent fungal infection was the primary cause of death in only one patient. The estimated 45% 2-year survival in this series is similar to that for other patients with high risk hematologic malignancy undergoing stem cell transplantation. We conclude that suspected prior invasive fungal infection should not preclude the use of allogeneic stem cell transplantation.     

Pharmacological conversion of gut epithelial cells into insulin-producing cells lowers glycemia in diabetic animals

As a highly regenerative organ, the intestine is a promising source for cellular reprogramming for replacing lost pancreatic β cells in diabetes. Gut enterochromaffin cells can be converted to insulin-producing cells by forkhead box O1 (FoxO1) ablation, but their numbers are limited. In this study, we report that insulin-immunoreactive cells with Paneth/goblet cell features are present in human fetal intestine. Accordingly, lineage-tracing experiments show that, upon genetic or pharmacologic FoxO1 ablation, the Paneth/goblet lineage can also undergo conversion to the insulin lineage. We designed a screening platform in gut organoids to accurately quantitate β-like cell reprogramming and fine-tune a combination treatment to increase the efficiency of the conversion process in mice and human adult intestinal organoids. We identified a triple blockade of FOXO1, Notch, and TGF-β that, when tested in insulin-deficient streptozotocin (STZ) or NOD diabetic animals, resulted in near normalization of glucose levels, associated with the generation of intestinal insulin-producing cells. The findings illustrate a therapeutic approach for replacing insulin treatment in diabetes.     

Self-report questionnaires in five rheumatic diseases comparisons of health status constructs and associations with formal education level

Self-report questionnaire scales to assess various constructs of health status were compared in 602 patients with five rheumatic diseases, including 134 rheumatoid arthritis (RA), 216 osteoarthritis (OA), 84 fibromyalgia, 124 systemic lupus erythematosus (SLE), and 43 scleroderma patients. RA patients showed significantly higher degrees of difficulty, dissatisfaction, and pain in performing eight activities of daily living (ADL) compared to patients with the other four diseases (P < 0.01), while SLE patients reported the least difficulty, dissatisfaction and pain. Fibromyalgia patients showed significantly higher scores on a visual analog pain scale than patients with the other four diseases (P < 0.05), followed by OA patients. Fibromyalgia patients reported significantly higher levels of learned helplessness, assessed according to a rheumatology attitudes index (RAI), than patients with all other diseases, and scleroderma patients showed significantly lower RAI scores (P < 0.05). Patients with all five diseases who had not completed high school showed poorer clinical status than patients who had completed high school on all six scales. Significant differences in questionnaire scores were seen for 24 of 30 comparisons (five diseases and six scales) according to formal education level, versus only two according to age, and none according to duration of disease.     

Comparison of Traumatic Intracranial Hemorrhage Expansion and Outcomes Among Patients on Direct Oral Anticoagulants Versus Vitamin k Antagonists

Neurocritical Care - With increasing use of direct oral anticoagulants (DOACs) and availability of new reversal agents, the risk of traumatic intracranial hemorrhage (tICH) requires better...