Brookdale's primary and secondary service areas together comprise 1 million residents. It serves most of Eastern Brooklyn: Brownsville, East New York, Canarsie and East Flatbush.In 2017, it was described as "struggling." In 2009 they had 'let go' 240 employees.
INTRODUCTION: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a significant contributor to morbidity and mortality, linked to adverse cardiovascular outcomes. While extensive research highlights the cardiovascular burden in non-lean MASLD, lean MASLD remains comparatively understudied. To address this gap, our study evaluates cardiovascular outcomes in lean MASLD compared with non-lean MASLD. METHODS: This is a retrospective cohort study of patients with MASLD identified in the multi-institutional database, TriNetX. Lean MASLD was defined as a body mass index <25 kg/m2. Leveraging 1:1 propensity score matching, we balanced baseline characteristics, including age, sex, comorbidities, laboratory values, and medication use. Cox proportional hazards models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for cardiovascular events, cerebrovascular outcomes, new-onset heart failure, and all-cause mortality over 1-, 3-, 5-, and 7-year follow-up. RESULTS: After matching, there were 67,519 patients in both groups. At 7-year follow-up, lean patients with MASLD demonstrated significantly higher rates of new onset heart failure compared with non-lean patients with MASLD (HR: 1.23, 95% CI: 1.16-1.31, P < 0.0001), composite cardiovascular events (HR: 1.21, 95% CI: 1.13-1.30, P < 0.0001), cerebrovascular events (HR: 1.33, 95% CI: 1.24-1.43, P < 0.0001), and all-cause mortality (HR: 1.48, 95% CI: 1.38-1.59, P < 0.0001). These increased risks were noted at 1-, 3-, and 5-year follow-up. DISCUSSION: Patients with lean MASLD are at significantly higher risks of cardiovascular events and all-cause mortality compared with non-lean patients with MASLD. Further research is needed to clarify the underlying pathophysiology and develop tailored interventions to improve outcomes for this growing population.
IntroductionOver four years have passed since the World Health Organization (WHO) declared COVID-19 a pandemic. During the early phase of the pandemic (approximately March 2020 to June 2021), effective therapeutics and vaccines were not available. Many countries implemented societal infection control measures to curb the spread of the virus. The United States and Sweden adopted markedly different public health strategies. The United States declared a national emergency and implemented strict measures, including lockdowns and school closures, whereas Sweden relied largely on voluntary guidelines without mandating extensive societal controls. Understanding how these divergent approaches affected the mental health of children and adolescents during this critical initial period can inform future health policies and interventions. This scoping review aimed to examine how COVID-19 and associated public health measures impacted the mental health of children and adolescents in the United States and Sweden during the early phase of the pandemic (March 2020 to June 2021). MethodsWe carried out a scoping review following PRISMA-ScR guidelines. English-language, peer-reviewed articles published between January 2020 and June 2022 were identified in MEDLINE, PubMed, Google Scholar, MedRxiv, PsyArXiv, and WHO Global Literature on coronavirus disease. Studies focusing on mental health outcomes in U.S. and Swedish youth (ages 3–24) during the early phase of the pandemic were included. Data extraction and quality appraisal followed Joanna Briggs Institute guidelines. ResultsOf 1,596 references screened, 32 studies (22 from the U.S. and 10 from Sweden) met inclusion criteria, involving a combined 776,586 participants. The majority were cross-sectional studies. U.S. data indicated a deterioration in mental health due to stringent infection control measures, school closures, and social isolation, affecting the well-being of children and adolescents and increasing symptoms of anxiety, depression, and loneliness. In contrast, Sweden’s decision to keep primary schools open preserved a sense of normalcy, contributing to comparatively stable mental health outcomes with fewer signs of increased distress. DiscussionDuring the early pandemic phase, U.S. children and adolescents experienced worsening mental health as lockdowns persisted, while Swedish youth showed fewer adverse changes. Factors, such as developmental stage, socioeconomic status, and access to supportive services, influenced outcomes. This scoping review underscores the need for balanced public health policies that mitigate infection risks while supporting the mental health and well-being of young populations. ConclusionThe early phase of the COVID-19 pandemic had significant but variable mental health effects on children and adolescents. Stringent restrictions in the U.S. correlated with increased psychological distress, whereas Sweden’s less disruptive approach may have helped maintain better well-being. Understanding these early responses can inform future strategies for addressing the mental health needs of youth during global crises.
Background:Endoscopic sleeve gastroplasty (ESG) facilitates 13.6%-16.2% total body weight loss (TBWL) at 12 months, but falls short of that seen with surgical vertical sleeve gastrectomy, in part owing to the retention of the gastric fundus. In adults with obesity, gastric fundal mucosal ablation (GFMA) reduces fasting plasma ghrelin (FPG), hunger, cravings, and accommodation. Combined GFMA-ESG could improve TBWL. This study aimed to evaluate the effectiveness and safety of sequential GFMA followed by ESG in adults with obesity, building on previously published 6-month results of GFMA alone. Methods:This was a prospective, first-in-human, two-phase clinical trial. Ten participants underwent GFMA, followed by ESG at month 6, and were followed for 12 months post-ESG (18 months total). GFMA was performed using hybrid argon plasma coagulation to lift and ablate the entire gastric fundal mucosa. ESG was performed using standard full-thickness endoscopic suturing of the gastric body. The primary end point was TBWL; secondary end points were safety and changes in FPG, maximum tolerated volume (MTV), and validated appetite questionnaires. Results:Mean TBWL was 22.5% (SD 8.3%) at month 18. Hunger-related behaviors and eating self-efficacy showed sustained improvements. FPG was decreased at month 6 and returned toward baseline by month 18, while MTV remained suppressed. No serious adverse events occurred. Conclusions:Sequential GFMA-ESG is safe and induces substantial weight loss, reduced MTV of ingested nutrients, and improved behavioral measures. This combination approach builds on prior traditional ESG and GFMA-only results and may represent a promising advancement of endoscopic therapeutic options for weight loss.
OBJECTIVES:To perform an updated meta-analysis assessing the effect of routine cerebral embolic protection (CEP) use on the incidence of stroke-disabling and non-disabling-following transcatheter aortic valve replacement (TAVR). METHODS:Electronic databases were systematically searched through August 2025 for eligible randomized controlled trials (RCTs) comparing CEP versus no CEP in TAVR. The primary outcomes were the incidence of overall stroke, disabling stroke, and non-disabling stroke at 2-5 days and 30 days post-procedure. Random-effects model was used to estimate risk ratios (RR) with 95% confidence intervals (CI). Evaluation of the certainty of evidence was done following the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Trial sequential analysis was performed to assess the conclusiveness and the reliability of the data. RESULTS:Eight RCTs, including 11,692 patients, were analyzed. No statistically significant difference was observed in overall stroke incidence between CEP and control groups at 2-5 days (RR = 0.95; 95% CI: 0.75-1.19; p = 0.64) or at 30 days (RR = 0.93; 95% CI: 0.57-1.53; p = 0.79). Disabling stroke rates were also similar at 2-5 days (RR = 0.70; 95% CI: 0.41-1.18; p = 0.18) and at 30 days (RR = 1.18; 95% CI: 0.36-3.87; p = 0.78). Non-disabling stroke showed no significant difference at either time point. Safety outcomes, including major bleeding, vascular complications, and acute kidney injury, were also not significantly different. CONCLUSION:This updated meta-analysis found that a routine CEP strategy during TAVR was not associated with a statistically significant reduction in overall, disabling, or non-disabling stroke. The neutral effect on safety endpoints suggests a limited role for routine CEP use, although smaller benefits, device-specific effects, or benefits in selected higher-risk patients cannot be excluded.
We examined developmental trajectories of receptive and expressive language abilities in children aged 1 to 5 years and beyond. We retrospectively recruited 158 children. Using the Sequenced Language Scale for Infants and the Preschool Receptive-Expressive Language Scale, children were grouped as typically developing (TD), mildly delayed (MD), or severely delayed (SD). Language was assessed under 3 age groups: under 2 years, 2 to <5 years (in 6-month intervals), and ≥5 years. Most TD children before age 5 remained TD, although some transitioned to MD or SD, especially after 3.5 years. The MD children at younger ages often improved to TD, but this likelihood declined approaching age 5. Those classified as SD had a lower chance of improvement, with fewer transitioning to MD or TD. The likelihood of improvement from MD and SD decreased with age. Children exhibiting both MD and SD demonstrate potential for improvement; however, the likelihood decreases with age.
