Cardiology professionals' views of social robots in augmenting heart failure patient care.

Aims: Social robots are arriving to the modern healthcare system. Whether patients with heart failure, a prevalent chronic disease with high health and human costs would derive benefit from a social robot intervention has not been investigated empirically. Diverse healthcare provider's perspectives are needed to develop an acceptable and feasible social robot intervention to be adopted for the clinical benefit of patients with heart failure. Using a qualitative research design, this study investigated healthcare providers' perspectives of social robot use in heart failure patient care. Methods and results: Interdisciplinary healthcare providers from a tertiary care cardiac hospital completed a structured individual interview and a supplemental questionnaire. The framework method was used to analyse the qualitative data. Respondents (n = 22; saturation was reached with this sample; 77% female; 52% physicians) were open to using social robots to augment their practice, particularly with collecting pertinent data and providing patient and family education and self-management prompts, but with limited responsibility for direct patient care. Prior to implementation, providers required robust evidence of: value-added beyond current remote patient monitoring devices, patient and healthcare provider partnerships, streamlined integration into existing practice, and capability of supporting precision medicine goals. Respondents were concerned that social robots did not address and masked broader systemic issues of healthcare access and equity. Conclusion: The adoption of social robots is a viable option to assist in the care of patients with heart failure, albeit in a restricted capacity. The results inform the development of a social robotic intervention for patients with heart failure, including improving social robot efficiencies and increasing their uptake, while protecting patients' and providers' best interest.

Caregiver Distress and Coronary Artery Disease: Prevalence, Risk, Outcomes, and Management.

PURPOSE OF REVIEW: Caregivers of patients with coronary artery disease (CAD) are integral to the health care system and contribute substantially to patients' management. The purpose of this review is to provide a narrative synthesis of existing research on caregiving for patients who experienced an acute coronary syndrome (MI/unstable angina) and/or coronary revascularization (PCI/CABG). RECENT FINDINGS: Thirty-one articles are included in this review. Overall, caregiver distress is low to moderate, ranging from 6 to 67% of caregivers, and seems to dissipate over time for most caregivers. Interventions have demonstrated success in reducing the distress of caregivers of patients with CAD. Due to the heterogeneity in study samples, measurements used, and timing of assessments and programming, these results are far from definitive. Although evidence is accumulating, further advancement in caregiving science and clinical care is required to adequately understand and respond to the needs of caregivers throughout the patient's illness trajectory.

Gnathostomiasis in a patient who frequently consumes sushi.

A 45-year-old woman presented for evaluation of a solitary pruritic nodule on the abdomen that suddenly appeared 3 weeks before. She was healthy without a significant medical history, travel history, exposures, medications, or pets. She reported that she consumed sushi at least weekly in the city of San Francisco. A punch biopsy revealed a superficial and deep perivascular and interstitial infiltrates consisting of lymphocytes, plasma cells, and many eosinophils. Most notably, there was a parasite centered in the reticular dermis with prominent lateral chords, a well-developed muscular esophagus, and an intestine that contained a brush border and multinucleate cells. Evaluation of these histological sections by the Centers for Disease Control and Prevention determined the parasite to be a nematode of the genus Gnathostoma. The patient underwent a systemic work-up for gnathostomiasis, including imaging, and no other abnormalities were found. She completed a 3-week course of albendazole and has remained asymptomatic since the biopsy of her abdominal lesion. Although gnathostomiasis is often a systemic illness, this patient did well with apparently only localized cutaneous disease. Gnathostomiasis should be considered in patients who present with nonspecific papules and nodules, especially when there is a history of frequent consumption of raw fish.

Eccrine porocarcinoma arising in two African American patients: distinct presentations both treated with Mohs micrographic surgery.

Abstract Background Eccrine porocarcinoma (EPC) is a rare, malignant adnexal tumor that has been reported only three times specifically in African American individuals. Diagnosis and treatment of EPC is important, given the 20% local recurrence and regional metastatic rates. However, no standard of care has been developed to guide effective treatment. Methods We report two distinct clinical presentations of EPC, both in African Americans, and discuss a review of the literature. Results The neoplasms were successfully removed from both patients by Mohs micrographic surgery. Conclusions These two cases illustrate that EPC can have a variety of presentations and can occur in African Americans. Although there is no standard of care for treating EPC, Mohs is becoming a common technique of removing these lesions.

Dermatitis artefacta.

BACKGROUND: Dermatitis artefacta (DA) is difficult to diagnose by clinical findings alone. Histopathologic analysis may rule out organic disorders and in some cases establish, in conjunction with microanalytic techniques, a definite diagnosis. OBJECTIVE: We report a young woman with DA in the form of recurrent abscesses whose diagnosis was aided by the identification of subcutaneous foreign material through histologic and microanalytic methods. METHODS: Histologic examination showed foreign body giant cell reaction with polarizable material, which was identified as cellulose by energy dispersive x-ray analysis and Fourier transform infrared spectrometry. RESULTS: Self-injection of exogenous matter was suspected. Referral to an expert in psychodermatology resulted in the diagnosis of multiple psychiatric comorbidities commonly associated with DA. Initiation of antidepressants resulted in marked improvement in her skin disease, as well as her mood and affect. CONCLUSION: We emphasize the importance of interdisciplinary collaboration between dermatologists, dermatopathologists, and mental health professionals in the management of DA.

Srcasm modulates EGF and Src-kinase signaling in keratinocytes.

The Src-activating and signaling molecule (Srcasm) is a recently described activator and substrate of Src-family tyrosine kinases (SFKs). When phosphorylated at specific tyrosines, Srcasm associates with Grb2 and p85, the regulatory subunit of phosphoinositide 3-kinase; however, little is known about the role of Srcasm in cellular signaling. Data presented here demonstrate that epidermal growth factor (EGF) receptor ligands promote the tyrosine phosphorylation of endogenous and adenovirally transduced Srcasm in keratinocytes, and that increased levels of Srcasm activate endogenous SFKs, with a preference for Fyn and Src. In addition, Srcasm potentiates EGF-dependent signals transmitted by SFKs in keratinocytes. Tyrosine phosphorylation of Srcasm is dependent on growth factors and the activity of EGFR and SFKs. Increased Srcasm expression enhances p44/42 mitogen-activated protein kinase activity and Elk-1-dependent transcriptional events. Elevated Srcasm levels inhibit keratinocyte proliferation while promoting specific aspects of keratinocyte differentiation. Lastly, Srcasm levels are decreased in human cutaneous neoplasia. Collectively, these data demonstrate that Srcasm plays a role in linking EGF receptor- and SFK-dependent signaling to differentiation in keratinocytes.

Compartmentalization of integrin alpha6beta4 signaling in lipid rafts.

Integrin alpha6beta4 signaling proceeds through Src family kinase (SFK)-mediated phosphorylation of the cytoplasmic tail of beta4, recruitment of Shc, and activation of Ras and phosphoinositide-3 kinase. Upon cessation of signaling, alpha6beta4 mediates assembly of hemidesmosomes. Here, we report that part of alpha6beta4 is incorporated in lipid rafts. Metabolic labeling in combination with mutagenesis indicates that one or more cysteine in the membrane-proximal segment of beta4 tail is palmitoylated. Mutation of these cysteines suppresses incorporation of alpha6beta4 in lipid rafts, but does not affect alpha6beta4-mediated adhesion or assembly of hemidesmosomes. The fraction of alpha6beta4 localized to rafts associates with a palmitoylated SFK, whereas the remainder does not. Ligation of palmitoylation-defective alpha6beta4 does not activate SFK signaling to extracellular signal-regulated kinase and fails to promote keratinocyte proliferation in response to EGF. Thus, compartmentalization in lipid rafts is necessary to couple the alpha6beta4 integrin to a palmitoylated SFK and promote EGF-dependent mitogenesis.