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Background: Research indicates a high prevalence of depressive disorders in individuals with autism spectrums disorders (ASD), highlighting a need for depression screening in this population. Both depression screening tools used in the general population and tools developed specifically for individuals with ASD are used in the ASD population. Because depressive symptoms may manifest differently in individuals with ASD, it is important to establish the psychometric properties of depression instruments in individuals with ASD to determine whether and how these instruments can be applied in assessing these individuals., Objective: Our objective was to synthesize knowledge regarding the psychometric properties of (a) depression instruments developed for the general populations and (b) depression instruments developed specifically for individuals with ASD., Methods: A scoping review was conducted using Covidence to identify, screen, and review available literature on the use and psychometric properties of generalized and ASD-specific depression instruments in individuals with ASD., Results: Results for both generalized and ASD-specific instruments indicated moderate psychometric strength, enough for these instruments to be potentially helpful in psychiatric assessments but not enough to be conclusive on their own. The data are limited by the small number of studies examining this population, that is, only 1 to 3 articles for each instrument, and the often-limited number of psychometric measurements taken in each study., Conclusions: As the prevalence of depression in individuals with ASD is high, reliable and valid measures are needed. Current research shows some support for existing instruments, although additional, more robust research is needed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Normal aging often leads to cognitive decline, and oldest old people, over 80 years old, have a 15% risk of developing neurodegenerative diseases. Therefore, it is important to have appropriate tools to assess cognitive function in old age. The study aimed to provide new norms for neuropsychological tests used to evaluate the cognitive abilities in people aged 80 years and older in France, focusing on the impact of education and gender differences., Method: 107 healthy participants with an average age of 85.2 years, with no neurological history or major cognitive deficits were included. A comprehensive neuropsychological assessment was performed, covering several cognitive functions such as memory, visuospatial abilities, executive functions, attention, processing speed, and praxis., Results: Individuals with lower levels of education performed poorly on some tests and took longer to complete. Gender differences were observed, with women outperforming men in verbal episodic memory, while men showed better performance in visuoconstructive tasks. The participants showed lower performance in verbal episodic memory compared to norms established in previous French studies. In relation to executive functions, participants were slower to perform complex tasks than participants in previous studies., Conclusion: This study provides cognitive norms specifically adapted to the oldest old population, which differ from established norms for younger aging adults. It highlights the importance of including these norms in future clinical and scientific investigations. The findings underscore the importance of education on cognitive abilities and emphasize the need to consider gender differences when assessing cognitive functions in aging populations.

Introduction: Mounting evidence indicates that an individual's humoral adaptive immune response plays a critical role in the setting of SARS-CoV-2 infection, and that the efficiency of the response correlates with disease severity. The relationship between the adaptive immune dynamics in the lower airways with those in the systemic circulation, and how these relate to an individual's clinical response to SARS-CoV-2 infection, are less understood and are the focus of this study., Material and Methods: We investigated the adaptive immune response to SARS-CoV-2 in paired samples from the lower airways and blood from 27 critically ill patients during the first wave of the pandemic (median time from symptom onset to intubation 11 days). Measurements included clinical outcomes (mortality), bronchoalveolar lavage fluid (BALF) and blood specimen antibody levels, and BALF viral load., Results: While there was heterogeneity in the levels of the SARS-CoV-2-specific antibodies, we unexpectedly found that some BALF specimens displayed higher levels than the paired concurrent plasma samples, despite the known dilutional effects common in BALF samples. We found that survivors had higher levels of anti-spike, anti-spike-N-terminal domain and anti-spike-receptor-binding domain IgG antibodies in their BALF (p<0.05), while there was no such association with antibody levels in the systemic circulation., Discussion: Our data highlight the critical role of local adaptive immunity in the airways as a key defence mechanism against primary SARS-CoV-2 infection., Competing Interests: Conflict of interest: Other than the funding disclosed in the Support Statement, there are no further conflicts of interest to disclose., (Copyright ©The authors 2024.)

Background: Childhood urinary tract infection (UTI) can cause renal scarring, and possibly hypertension, chronic kidney disease (CKD), and end-stage renal failure (ESRF). Previous studies have focused on selected populations, with severe illness or underlying risk factors. The risk for most children with UTI is unclear., Aim: To examine the association between childhood UTI and outcomes in an unselected population of children., Design and Setting: A retrospective population-based cohort study using linked GP, hospital, and microbiology records in Wales, UK., Method: Participants were all children born in 2005-2009, with follow-up until 31 December 2017. The exposure was microbiologically confirmed UTI before the age of 5 years. The key outcome measures were renal scarring, hypertension, CKD, and ESRF., Results: In total, 159 201 children were included; 77 524 (48.7%) were female and 7% ( n = 11 099) had UTI before the age of 5 years. A total of 0.16% ( n = 245) were diagnosed with renal scarring by the age of 7 years. Odds of renal scarring were higher in children by age 7 years with UTI (1.24%; adjusted odds ratio 4.60 [95% confidence interval [CI] = 3.33 to 6.35]). Mean follow-up was 9.53 years. Adjusted hazard ratios were: 1.44 (95% CI = 0.84 to 2.46) for hypertension; 1.67 (95% CI = 0.85 to 3.31) for CKD; and 1.16 (95% CI = 0.56 to 2.37) for ESRF., Conclusion: The prevalence of renal scarring in an unselected population of children with UTI is low. Without underlying risk factors, UTI is not associated with CKD, hypertension, or ESRF by the age of 10 years. Further research with systematic scanning of children's kidneys, including those with less severe UTI and without UTI, is needed to increase the certainty of these results, as most children are not scanned. Longer follow-up is needed to establish if UTI, without additional risk factors, is associated with hypertension, CKD, or ESRF later in life., (© The Authors.)

Background: People with intellectual and developmental disabilities are among the most underserved in an inequitable healthcare system., Methods: Using Arksey and O'Malley's methodology and a social determinants of health framework, we conducted a scoping review of literature on the state of practice in education of healthcare professionals in the health and healthcare needs of this population., Results: Searches found 4948 articles, with 182 included in the final review. Themes identified included gaps of not being informed by workforce needs, continued use of the medical model of care, not addressing intersectionality with racial/ethnic and other discriminations, and lack of involvement of the population in developing/evaluating programs and promising trends of development of competency-based interprofessional programs with experiential learning., Conclusion: We provide recommendations for best practices in a concerted effort to educate a healthcare workforce equipped with the knowledge and skills to address the health needs of this population., (© 2024 The Authors. Journal of Applied Research in Intellectual Disabilities published by John Wiley & Sons Ltd.)

Aging is marked by a memory decline related to an executive function decline. Physical activity (PA) has beneficial effects on both executive functions and memory, especially in aging. The protective effects of PA on these two cognitive abilities have always been studied separately, despite the well-established relationship between memory and executive functions. Our objective was to explore whether the benefits of PA on memory could be explained by reduced age-related changes in executive functions.Nineteen young adults (27.16 years old) and 25 older adults (69.64 years old) performed a resource-dependent memory task, three executive tasks and completed a PA questionnaire (measuring sports and leisure PA). Age group and PA effects on memory and executive performance were analyzed with generalized linear models. Mediation analyses were calculated using method of causal steps approach with a non-parametric bootstrapping procedure.The results confirmed the effects of age and PA on memory and executive performance. A significant interaction confirmed the protective effect of PA on age-related cognitive performance. PA was positively correlated with performance in both memory and executive tasks, but only in the older adults. Although each predictor alone (age, executive functions and PA) significantly explained memory performance in older adults, only the effect of PA on memory performance remained significant when all the predictors were introduced in the analyses.PA mediates the effects of age and executive functions on memory performance. This suggests that PA protects older adults against memory decline by reducing the decline in executive functioning., (© 2024. The Author(s).)

This study investigated the influence of kinematics observation (i.e., observing action from only the motion of the main joints of an actor) on episodic memory performance differences between young and older adults. To this end, 42 young (20-35 years) and 45 older (60-75 years) participants performed a free recall task in two different conditions: either after an encoding phase consisting of the visual presentation and reading of action verbs or after an encoding phase consisting of the visual presentation and naming of point-light displays of humans performing the same actions. Results showed a beneficial effect of point-light display encoding for both young and older participants but with a more pronounced benefit for the older participants compared to young adults. These findings are discussed in relation to the embodied view of memory which considers that memory is directly linked to the sensorimotor experiences and the environmental support hypothesis which postulates that elaborate processing can improve memory performance. In conclusion, kinematic observation could constitute an interesting potential intervention for supporting memory in older adults., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Valganciclovir (VGC) was used in a randomized clinical trial in patients with disseminated Kaposi Sarcoma/human immunodeficiency virus (DKS/HIV) as add-on therapy to evaluate the proinflammatory axis tumor necrosis factor (TNF) and its receptors (TNFRs) in T cells. Two treatment schedules were used: an experimental regime (ER) and a conventional treatment (CT). Mononuclear cells from patients with DKS/HIV were obtained at baseline (W0), 4 (W4), and 12 weeks (W12). Ten DKS/HIV patients received CT (antiretroviral therapy [cART]) and 10 ER (valganciclovir [VGC] initially, plus cART at the fourth week). HIV+ without KS and HIV- patient groups were included as controls. Correlation between T-cell subsets and HHV-8 viral load (VL) and a multivariate linear regression was performed. Data showed that DKS/HIV patients have an increased frequency of CD8+ T cells, which display a high density of CD8 expression. The ER scheme increases naïve and central memory CD4+ T cells at W4 and W12 of follow-up and induces a balanced distribution of activated CD4+ T-cell subsets. Moreover, ER decreases solTNFR2 since W4 and CT decreased the transmembrane forms of TNF axis molecules. Although CT induces a positive correlation between HHV-8 VL and TNFRs, the use of ER positively correlates with TNF and TNFRs levels through follow-up and a moderate correlation with HHV-8 VL and TNF soluble levels. In conclusion, VGC, as an add-on therapy in DKS/HIV patients, gradually modulates the activation of CD4+ T-cell subsets and the TNF/TNFRs axis, suggesting a better regulation of the inflammatory status., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Immunology.)

Competing Interests: The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Hematopoietic cell transplantation (HCT) treats many blood conditions but remains underused due to complications such as graft-versus-host disease (GvHD). In GvHD, donor immune cells attack the patient, requiring powerful immunosuppressive drugs like glucocorticoids (GCs) to prevent death. In this study, we tested the hypothesis that donor cell conditioning with the glucocorticoid fluticasone propionate (FLU) prior to transplantation could increase hematopoietic stem cell (HSC) engraftment and reduce GvHD. Murine HSCs treated with FLU had increased HSC engraftment and reduced severity and incidence of GvHD after transplantation into allogeneic hosts. While most T cells died upon FLU treatment, donor T cells repopulated in the hosts and appeared less inflammatory and alloreactive. Regulatory T cells (Tregs) are immunomodulatory and survived FLU treatment, resulting in an increased ratio of Tregs to conventional T cells. Our results implicate an important role for Tregs in maintaining allogeneic tolerance in FLU-treated grafts and suggest a therapeutic strategy of pre-treating donor cells (and not the patients directly) with GCs to simultaneously enhance engraftment and reduce GvHD upon allogeneic HCT., (© 2023 The Authors. Published under the terms of the CC BY 4.0 license.)

Background: Depressive disorders are frequently mis- and underdiagnosed in individuals with autism spectrum disorders (ASD)., Objective: Our objective was to identify and synthesize current knowledge regarding (1) the presentation of depressive symptoms and (2) the use of self-reports in assessing depressive symptoms in individuals with ASD and comparisons between self-reported and observer-reported symptoms. A scoping review was conducted to capture the full range of literature on the topic and to identify research gaps., Methods: Articles were identified through a search of academic literature and screened for relevance to the aims of the review., Results: In addition to typical depression symptoms, individuals with ASD may demonstrate atypical symptoms such as changes in autistic symptoms, self-injurious behavior, and psychomotor changes. Moreover, the review revealed a bias toward observer-reports of symptoms. Self-reports frequently were not included or were ascribed less weight than observer-reports. Self-reports typically differed from reports given by parents or other caregivers, but a consistent pattern in these differences has not been established., Conclusions: Further research on the use of self-reports in assessing depressive symptoms in individuals with ASD is needed. Self-reports may provide information not obtainable through observer-reports, and integrating both self- and observer-reports in psychiatric evaluations may produce more comprehensive and accurate assessments.

Working memory-related neural activity varies with task load, and these neural variations can be constrained by working memory capacity (WMC). For instance, some studies suggest that parietal and frontal P300 amplitudes, reflecting working memory functioning, vary differentially with task load and WMC. The present study explored whether the predominance of parietal over frontal P300 amplitude is related to WMC, and whether this relationship varies according to task load. Thirty-one adults aged 20-40 years performed a Sternberg task with two set sizes (2 vs. 6 items), during which event-related potentials were recorded. This allowed us to explore the P300 and estimate the magnitude of its parietal over frontal predominance, calculated as a parietal over frontal predominance index (PFPI). Participants also performed the Digit Span and alpha span tests, which were used to compute an independent index of WMC. Results revealed the classic parietal over frontal P300 predominance. They also indicated that the PFPI decreased as task load increased, owing mainly to an increase in frontal P300 amplitude. Interestingly, WMC was positively correlated with the PFPI, suggesting that individuals with greater WMC exhibited greater parietal over frontal predominance. These correlations did not vary across set sizes. Parietal over frontal predominance was reduced in individuals with lower WMC, who relied more on frontal neural resources. This frontal upregulation may have reflected the recruitment of supplementary attentional executive operations to compensate for less efficient working memory maintenance operations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: Flavoured e-liquids are especially appealing to young adults. The objective of the present study was to evaluate the effects of text warning labels (WLs) on e-liquid vials used in flavoured electronic cigarettes (e-cigarettes) on e-cigarette non-users' perceptions of harm, addictiveness, emotional valence, interest in trying e-cigarettes and visual attention., Methods: Young adults aged 18-25 years (n=313) who were non-e-cigarette users were recruited online and randomised to view images of one of two e-liquid vial conditions (with text WL or without text WL). Each participant was exposed to four images of e-liquid vials. After observing each image, participants reported interest in trying e-cigarettes, emotional valence, perceived harm and addictiveness. Additionally, participants completed an assessment of self-reported visual attention with a priori regions of interest (e-liquid branding and text WL)., Results: Separate two-way Analysis of Variance(ANOVA) that examined the main effects of sex and warning were used for each measure. Text WL on e-liquid vials decreased young adults' intention to use e-cigarettes (especially in men), increased harm perception and decreased appeal to the product. However, they did not influence the perceived addictiveness of e-cigarettes and rarely grabbed attention. Men perceived e-cigarettes as less harmful and less addictive., Conclusions: The results suggest that text WLs on e-liquid vials are moderately effective in preventing e-cigarette use in young adults. However, they capture less attention than the rest of the vial and fail to increase the perception of addictiveness. It is suggested to explore other types of design to increase the effectiveness of WLs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Organizing information is beneficial to episodic memory performance. Among several possible organizational strategies, two consist of organizing the information in semantic clusters (semantic organization) or self-organizing the information based on new associations that do not exist in semantic memory (subjective organization). Here, we investigated in a single study how these two organizational behaviors were underlined by different controlled processes and whether these relations were subjected to age-related differences. We tested 123 younger adults ( n = 63) and older adults ( n = 60) on two episodic memory tasks, one where the words were organizable and another where the words were not organizable, allowing for semantic and subjective organization, respectively. Additionally, participants were tested on three cognitive control tasks (Wisconsin Card Sorting Test, Stroop Test and Trail Making Test) and three working memory tasks (Backward Digit Span, Alpha Span and N -back test). Results revealed well-established age-related differences in terms of recall performance and organizational strategy implementation. More importantly, we found evidence that the different cognitive tests statistically yielded two different latent factors, a cognitive control factor and a working memory factor. Based on this dissociation, we found that only cognitive control contributed to semantic organization in all age groups whereas only working memory contributed to subjective organization, also in all age groups. These results shed new lights on our understanding of how controlled processes differently contribute to organizational behaviors in episodic memory. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Fusarium wilt of banana (Musa spp.), caused by the soil-borne fungus Fusarium oxysporum f. sp. cubense (Foc), is a major constraint to banana production worldwide (Dita et al., 2018). A strain of Foc that affects Cavendish (AAA) bananas in the tropics, called Foc tropical race 4 (TR4; VCG 01213), is of particular concern. Foc TR4 was first detected in Malaysia and Indonesia around 1990 but was restricted to Southeast Asia and northern Australia until 2012. The fungus has since been reported from Africa, the Indian subcontinent, and the Middle East (Viljoen et al., 2020). Foc TR4 was detected in Colombia in 2019 and in Perú in 2021 (Reyes-Herrera et al., 2020). The incursions into Latin America and the Caribbean (LAC) triggered global concerns, as 75% of international export bananas are produced in the region. Banana production in Venezuela, however, is primarily intended for domestic consumption (Aular and Casares, 2011). In 2021 the country produced 533,190 metric tons of banana on an area of 35,896 ha, with an approximate yield of 14,853 kg/ha (FAOSTAT, 2023). In July 2022, severe leaf-yellowing, and wilting, along with internal vascular discoloration of the pseudostem, were noted in Cavendish banana plants cultivar 'Valery' in the states of Aragua (10°11'8″N; 67°34'51″W), Carabobo (10º14'24″N; 67º48'51″W), and Cojedes (9°37'44″N; 68°55'4″W). Necrotic strands from the pseudostems of diseased plants were collected for identification of the causal agent using DNA-based techniques, vegetative compatibility group (VCG) analysis and pathogenicity testing. The samples were first surface disinfected and plated onto potato dextrose agar medium. Single-spored isolates were identified as F. oxysporum based on cultural and morphological characteristics, including white colonies with purple centres, infrequent macroconidia, abundant microconidia on short monophialides, and terminal or intercalary chlamydospores (Leslie and Summerell, 2006). Foc TR4 was identified from five isolates by endpoint and quantitative-PCR using four different primer sets (Li et al. 2013; Dita et al. 2010; Aguayo et al. 2017; Matthews et al. 2020). The same isolates were identified as VCG 01213 by successfully pairing nitrate non-utilizing (nit-1) mutants of the unknown strains with Nit-M testers of Foc TR4 available at Stellenbosch University (Leslie and Summerell, 2006). For pathogenicity testing, 3-month-old Cavendish banana plants cultivar 'Williams' were inoculated with isolates from Venezuela grown on sterile millet seed (Viljoen et al., 2017). Plants developed typical Fusarium wilt symptoms 60 days after inoculation, including yellowing of leaves that progressed from the older to the younger leaves, wilting, and internal discoloration of the pseudostem. Koch's postulates were fulfilled by reisolating and identifying Foc TR4 from the plants by qPCR (Matthews et al., 2020). These results provide scientific proof of the presence of Foc TR4 in Venezuela. The Venezuelan Plant Protection Organization (INSAI) has declared Foc TR4 as a newly introduced pest (January 19, 2023), and infested banana fields were placed under quarantine. Comprehensive surveys are now conducted in all production areas in Venezuela to assess the presence and impact of Foc TR4, and information campaigns were started to make farmers aware of biosecurity protocols. Collaborative initiatives and coordinated actions among all stakeholders are needed to prevent the spread of Foc TR4 to other countries in Latin America, and to develop Foc TR4-resistant bananas (Figueiredo et al. 2023).

Background: Congenital syphilis can cause severe morbidity, including miscarriage and stillbirth, and rates are increasing rapidly within the United States. However, congenital syphilis can be prevented with early detection and treatment of syphilis during pregnancy. Current screening recommendations propose that all women should be screened early in pregnancy, whereas women with elevated risks for congenital syphilis should be screened again later in pregnancy. The rapid increase in congenital syphilis rates suggests that there are still gaps in prenatal syphilis screening., Objective: This study aimed to examine associations between the odds of prenatal syphilis screening and sexually transmitted infection history or other patient characteristics across 3 states with elevated rates of congenital syphilis., Study Design: We used the Medicaid claims data from Kentucky, Louisiana, and South Carolina for women with deliveries between 2017 and 2021. Within each state, we examined the log-odds of prenatal syphilis screening as a function of the mother's health history, demographic factors, and Medicaid enrollment history. Patient history was established using a 4-year lookback period of the Medicaid claims data; in state A, sexually transmitted infection surveillance data were used to improve the sexually transmitted infection history., Results: The prenatal syphilis screening rates varied by state, ranging from 62.8% to 85.1% of deliveries to women without a recent history of sexually transmitted infections and from 78.1% to 91.1% of deliveries to women with a previous sexually transmitted infection. For the main outcome of syphilis screening at any time during pregnancy, deliveries associated with previous sexually transmitted infections had 1.09 to 1.37 times higher adjusted odds ratios of undergoing screening. Deliveries to women with continuous Medicaid coverage throughout the first trimester also had higher odds of syphilis screening at any time (adjusted odds ratio, 2.45-3.15). Among deliveries to women with a previous sexually transmitted infection, only 53.6% to 63.6% underwent first-trimester screening and this rate was still just 55.0% to 69.5% when considering only deliveries to women with a previous sexually transmitted infection and full first-trimester Medicaid coverage. Fewer delivering women underwent third-trimester screening (20.3%-55.8% of women with previous sexually transmitted infection). Compared with deliveries to White women, deliveries to Black women had lower odds of first-trimester screening (adjusted odds ratio, 0.85 in all states) but higher odds of third-trimester screening (adjusted odds ratio, 1.23-2.03), potentially impacting maternal and birth outcomes. For state A, linkage to surveillance data doubled the rate of detection of a previous sexually transmitted infection because 53.0% of deliveries by women with a previous sexually transmitted infection would not have had sexually transmitted infection history detected using Medicaid claims alone., Conclusion: A previous sexually transmitted infection and continuous preconception Medicaid enrollment were associated with higher rates of syphilis screening, but Medicaid claims alone do not fully capture the sexually transmitted infection history of patients. The overall screening rates were lower than would be expected given that all women should undergo prenatal screening, but the rates in the third trimester were particularly low. Of note, there are gaps in early screening for non-Hispanic Black women who had lower odds of first-trimester screening when compared with non-Hispanic White women despite being at elevated risk for syphilis., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Objective: There is a shortage of donor lungs relative to need, but overall donor organ utilization remains low. The most common reason for refusal is organ quality, but the standards applied to selection vary. In this study we sought to characterize differences in lung utilization according to quality across several clinically distinct recipient pools., Methods: Data on donor lungs recovered (April 2006 to September 2019) were extracted from the Scientific Registry of Transplant Recipients database. Organs were classified as ideal, standard, or extended quality according to their poorest metric among selected parameters. Subanalyses were performed on the basis of procedure type, age, lung allocation score, era, and alternative definitions of extended quality. Recipient traits and survival according to organ quality were assessed., Results: Of 156,022 lungs analyzed during the study period, 25,777 (16.5%) were transplanted. There was no difference in quality distribution for single and bilateral transplants. Young candidates were more likely to receive ideal (14.7% vs 12.3%) or standard (9.5% vs 8.2%) lungs, but not extended lungs (75.9% vs 79.5%; all P < .01). Absolute differences in distribution according to lung allocation score quartile were small (<2%). Extended quality donor utilization increased over time. Survival according to donor category was similar at 1 and 3 years post transplant in unadjusted and Cox regression analyses., Conclusions: Extended quality lungs comprise an increasing share of transplants in a national sample. Organ selection varies according to recipient age and lung allocation score. However, absolute differences in quality distribution are small, and adverse effects on outcomes are limited to organs with multiple extended qualifying characteristics., (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Executive control could be involved in neural capacity, which corresponds to the modulation of neural activity with increased task difficulty. Thus, by exploring the P300-an electrophysiological correlate of working memory-we examined the role played by executive control in both the age-related decline in working memory and neural capacity in aging. Event-related potentials (ERPs) were recorded while younger and older participants performed a Sternberg task with two set sizes (2 vs. 6 items), allowing us to calculate a neural capacity index. Participants also completed two control tasks (Stroop and 3-back tests), which were used to calculate a composite executive control index. Results indicated that working memory performance decreased with aging and difficulty. At the neural level, results indicated that the P300 amplitude varied with aging and also with task difficulty. In the low difficulty condition, frontal P300 amplitude was higher for older than for younger adults, whereas in the high difficulty condition, the amplitude of frontal and parietal P300 did not differ between both age groups. Results also suggest that task difficulty led to a decrease in parietal amplitude in both age groups and to an increase in frontal amplitude in younger but not older adults. Both executive control and frontal neural capacity mediated the age-related variance in working memory for older adults. Moreover, executive control mediated the age-related variance in the frontal neural capacity of older adults. Thus, the present study suggests a model for older adults in which executive control deficits with advancing age lead to less efficient frontal recruitment to cope with task difficulty (neural capacity), which in turn has a negative impact on working memory functioning., (© 2022. The Psychonomic Society, Inc.)

This study aimed to explore the effects of age and educational level on recall performance and organisational strategies used during recall as a function of the level of memory task difficulty. Younger ( n  = 55, age range = 20-39 years) and older ( n  = 45, age range = 65-75 years) adults learned a word list where the words were either already semantically grouped (easier) or presented in pseudo-random order (harder), and then recalled the words. The number of words recalled was calculated, and an index of clustering was computed to assess organisational strategies. Older adults recalled less words than the younger ones. Older adults with a higher educational level recalled more words than their counterparts with a lower educational level when the memory task was easier, but they all performed similarly on the harder memory task. Moreover, we noted a strong positive association between educational level and semantic organisation in older adults when the memory task was easier. Regardless of educational level, older adults used semantic organisation as much as younger adults when the memory task was easier. However, when the memory task was harder, older adults showed significantly less organisational strategies than younger adults, the latter using semantic organisation to boost their recall performance. In sum, the protective effect of educational level seems to be restricted on recall performance, but not organisational strategies, in easy memory tasks providing sufficient external information about the most efficient mnemonic strategy to use., Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00724-z., Competing Interests: Competing interestsWe declare no competing interests., (© The Author(s), under exclusive licence to Springer Nature B.V. 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The present study investigated the impact of cognitive reserve on episodic memory and metamemory control during aging using a multidimensional index of cognitive reserve and a measure of metamemory control abilities. We tested the hypotheses that cognitive reserve may play a protective role against age-related differences in episodic memory and metamemory control and that metamemory control may mediate the effect of cognitive reserve on episodic memory during aging. Young and older adults carried out a readiness-recall task in which task difficulty was manipulated through a variation of the nature of the cue-target pair link (weak vs. strong semantic associates). Episodic memory was assessed through recall performance, and metamemory by a task difficulty index reflecting the ability to adjust study time to task difficulty. Results confirmed that older adults recall fewer words, indicating an age-related deficit in episodic memory, and that older adults adjust less to task difficulty, suggesting impaired metamemory control. Findings also showed that metamemory control moderates the age-related decline in episodic memory and that cognitive reserve plays a protective role against age-related deficits in episodic memory and metamemory control. In addition, metamemory abilities mediated the beneficial effect of cognitive reserve on episodic memory performance during aging. Hence, this study sheds new light on the mechanisms underlying the impact of cognitive reserve on cognitive aging, highlighting the role of metacognitive processes., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Health guidelines are important tools to ensure that health practices are evidence-based. However, research on how these guidelines are implemented is scarce. This integrative review aimed to: identify the literature on evaluation of public health guidelines implementation to explore (a) the topics which public health guidelines being implemented and evaluated in their implementation process are targeting; (b) how public health guidelines are being translated into action and the potential barriers and facilitators to their implementation; and (c) which methods are being used to evaluate their implementation. A total of 2001 articles published since 2000 and related to both clinical and public health guidelines implementation was identified through searching four databases (PubMed, CINAHL, Web of Science, Scopus). After screening titles and abstracts, only 10 papers related to public health guidelines implementation, and after accessing full-text, 8 were included in the narrative synthesis. Data were extracted on: topic and context, implementation process, barriers and facilitators, and evaluation methods used, and were then synthesised in a narrative form using a thematic synthesis approach. Most of these studies focussed on individual behaviours and targeted specific settings. The evaluation of implementation processes included qualitative, quantitative and mixed-methods. The few articles retrieved suggest that evidence is still limited and highly context specific, and further research on translating public health guidelines into practice is needed., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Published by Elsevier Inc.)

The present study examined the effects of current physical exercise and age on episodic memory and fluid intelligence, assessed with a free-recall task and the Culture Fair Intelligence Test (Cattell, 1963) respectively, while statistically controlling for other cognitive reserve factors (educational level, leisure activities, and vocabulary level). Two hundred and eight participants aged 20 to 85 participated in the study. Physical exercise level was indexed by weekly frequency over the last 12 months using self-reported measurement (from none to 4 times a week). Overall, results show a beneficial effect of physical exercise especially from a weekly practice of 2 times, and significant interaction between physical exercise and age on episodic memory and fluid intelligence capacities indicating a reduced effect of age in more physically active participants. These results reinforce the view that physical exercise is a strong and specific reserve factor that reduces decline in some cognitive functions during aging., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Episodic memory decline with aging may be due to an age-related deficit in encoding processing, older adults having increasing difficulty to self-initiate encoding strategies that support later retrieval. Using event-related potentials (ERPs), the present study explored for the first time the neural correlates of successful encoding in a resource-dependent episodic memory task, in which participants had to self-initiate processes at both encoding and retrieval. At the behavioral level, results confirm the better memory performance of young than older adults. Comparing the neural activity elicited by studied items that were and were not subsequently recalled (Subsequent Memory Effect, SME), electrophysiological data revealed that younger adults showed a significant and sustained SME, shifting from parietal to frontal areas, suggesting that they self-initiated deep encoding strategies. In older adults, the duration of brain activity was shorter and located more in the parietal than frontal areas, suggesting that they used shallow rather than deep processes. Consistent with the hypothesis of a deficit in self-initiated strategies in aging, our findings suggest that when older adults are faced with a difficult memory task (no encoding support and no cue at retrieval), they engage fewer elaborative strategies than young adults, resulting in impaired episodic memory performance., (Published by Elsevier B.V.)

Objectives: Patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may develop end-stage lung disease requiring lung transplantation. We report the clinical course, pulmonary pathology with radiographic correlation, and outcomes after lung transplantation in three patients who developed chronic respiratory failure due to postacute sequelae of SARS-CoV-2 infection., Methods: A retrospective histologic evaluation of explanted lungs due to coronavirus disease 2019 was performed., Results: None of the patients had known prior pulmonary disease. The major pathologic findings in the lung explants were proliferative and fibrotic phases of diffuse alveolar damage, interstitial capillary neoangiogenesis, and mononuclear inflammation, specifically macrophages, with varying numbers of T and B lymphocytes. The fibrosis varied from early collagen deposition to more pronounced interstitial collagen deposition; however, pulmonary remodeling with honeycomb change was not present. Other findings included peribronchiolar metaplasia, microvascular thrombosis, recanalized thrombi in muscular arteries, and pleural adhesions. No patients had either recurrence of SARS-CoV-2 infection or allograft rejection following transplant at this time., Conclusions: The major pathologic findings in the lung explants of patients with SARS-CoV-2 infection suggest ongoing fibrosis, prominent macrophage infiltration, neoangiogenesis, and microvascular thrombosis. Characterization of pathologic findings could help develop novel management strategies., (© The Author(s) 2022. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: In many countries, including in the United Kingdom (UK), COVID-19 social distancing measures placed substantial restrictions on children's lives in 2020 and 2021, including closure of schools and limitations on play. Many children faced milestones such as transition to secondary school having missed several months of face-to-face schooling in the previous academic years., Methods: This paper examines change in mental health difficulties, life satisfaction, school connectedness, and feelings about transition to secondary school among 10-11-year-olds in Wales, UK, using data from repeat cross-sectional surveys before and after the onset of the COVID-19 pandemic. Participants were 4032 10-11-year-old schoolchildren. The first cohort completed a school-based survey in 2019 (prior to introduction of social distancing measures), and the second in 2021 (following full return to school after two rounds of school closure)., Results: The percentage of children reporting elevated emotional difficulties rose from 17% in 2019 to 27% in 2021 (Odds Ratio = 1.65; 95%CI = 1.23 to 2.20). There was no evidence of increased behavioural difficulties (OR = 1.04; 95%CI = 0.73 to 1.46). There was a tendency toward declines in life satisfaction in all analyses, but this intersected the null (OR = 0.86; 95%CI = 0.70 to 1.07). Children reported a high degree of school connectedness before and after the pandemic, with no evidence of change in ratings of teacher relationships, pupil relationships or pupil involvement in school life. There was no evidence of impacts of the pandemic on children's feelings about the transition to secondary school, with feelings becoming more positive as transition neared. Most findings were robust to a range of sensitivity analyses., Conclusions: Supporting children's emotional recovery from the COVID-19 pandemic is a public health priority requiring urgent and effective action at multiple levels of society. Maintaining connectedness to school through the pandemic may have played a role in preventing a steeper increase in child mental health difficulties., (© 2022. The Author(s).)

Objectives: Measure effectiveness of family nurse partnership (FNP) home-visiting programme in reducing maltreatment and improving maternal health and child health, developmental and educational outcomes; explore effect moderators, mediators; describe costs., Design: Follow-up of BB:0-2 trial cohort (ISRCTN:23019866) up to age 7 years in England using record linkage., Participants: 1618 mothers aged 19 years or younger and their firstborn child(ren) recruited to BB:0-2 trial at less than 25 weeks gestation and not mandatorily withdrawn from trial or opted out. Intervention families were offered up to a maximum of 64 home visits by specially trained nurses from pregnancy until firstborn child was 2 years old, plus usually provided health and social care support. Comparator was usual care alone., Outcome Measures: Primary outcome: state-verified child-in-need status recorded at any time during follow-up., Secondary Outcomes: referral to social services, child protection registration (plan), child-in-need categorisation, looked-after status, recorded injuries and ingestions any time during follow-up, early childcare and educational attendance, school readiness and attainment at key stage 1 (KS1), healthcare costs., Results: Match rates for 1547 eligible children (1517 singletons, 15 sets of twins) were 98.3% (NHS Digital) and 97.4% (National Pupil Database). There was no difference between study arms in the proportion of children being registered as in need (adjusted OR 0.98, 95% CI 0.74 to 1.31), or for any other measure of maltreatment. Children in the FNP arm were more likely to achieve a good level of development at reception age (school readiness) (adjusted OR 1.24, 95% CI 1.01 to 1.52). After adjusting for birth month, children in FNP arm were more likely to reach the expected standard in reading at KS1 (adjusted OR 1.26, 95% CI 1.02 to 1.57). We found no trial arm differences for resource use and costs., Conclusions: FNP did not improve maltreatment or maternal outcomes. There was evidence of small advantages in school readiness and attainment at KS1., Trial Registration Number: ISRCTN23019866., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

We explored whether control processes could account for age-related differences in internal strategy use, which in turn would contribute to episodic and working memory decline in aging. Young and older adults completed the internal strategy subscale of the Metamemory in Adulthood (MIA) questionnaire, a free-recall task (FRT), a reading span task (RST), and 3 executive control tasks (the Wisconsin Card Sorting Test, the Initial Letter Fluency Test, and the Digit Symbol Substitution Test) allowing us to calculate a composite index of control processes. Results indicated that both self-reported internal strategy use and control processes index accounted for a significant proportion of the age-related variance in the FRT and the RST. However, once the control processes index was controlled for, variance in both the FRT and RST explained by internal strategy use were significantly reduced. Additionally, age-related variance in internal strategy use was mediated by the control processes index. These results suggest a cascade model in which individual control level would mediate age-related differences in internal strategy use, which in turn would mediate age-related differences in episodic and working memory performance. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: Today's primary school children have grown up in a climate of strong smoking restrictions, decreasing tobacco use, and the emergence of e-cigarettes. Children's exposure to tobacco declined substantially in years following the introduction of smoke-free legislation, with smoking uptake and perceived smoking norms declining. There is debate regarding whether emergence of e-cigarettes may interrupt trends in children's smoking perceptions, or offer a means for adults to limit children's exposure to tobacco. This study examines change in children's tobacco and e-cigarettes experimentation (ever use), exposure to secondhand smoking and vaping, and perceived smoking norms., Methods: Data from four, repeat cross-sectional surveys of Year 6 primary school pupils (age 10-11 years) in Wales in 2007, 2008, 2014 and 2019 (n = 6741) were combined. E-cigarette use and perceptions were included in 2014 and 2019 surveys. Analyses used binary logistic regression analyses, adjusted for school-level clustering., Results: Child tobacco experimentation and most indicators of exposure to tobacco smoke indicated a graded decreasing trend over time from 2007 to 2019. Exposure to e-cigarettes increased from 2014 to 2019, as did pupil awareness of e-cigarettes (OR = 2.56, 95%CI = 2.12-3.10), and parental use (OR = 1.26, 95%CI = 1.00-1.57). A decrease in child e-cigarette experimentation was not significant (OR = 0.80, 95%CI = 0.57-1.13). Children's normative perceptions for smoking by adults and children indicated a graded decrease over time (OR = 0.66, 95%CI = 0.54-0.80; OR = 0.69, 95%CI = 0.55-0.86; respectively from 2014 to 2019). However, fewer reported disapproval of people smoking around them in 2019 relative to 2014 (OR = 0.68, 95%CI = 0.53-0.88). Higher exposure to tobacco cigarettes and e-cigarettes in public places, cars and households were associated with favourable normative perceptions for tobacco smoking; however in models adjusted for exposure to both associations of e-cigarette exposure were attenuated., Conclusion: Children's experimentation with and exposure to tobacco, and their perceptions of smoking as a normative behaviour, have continued to decline alongside growth in exposure to e-cigarettes. Although a large majority of pupils reported they minded people smoking around them, there was some evidence of diminishing disapproval of secondhand smoke since 2007. Further research is needed to understand whether use of e-cigarettes in cars and homes is displacing prior smoking or being introduced into environments where smoking had been eliminated., (© 2021. The Author(s).)

Respiratory failure is associated with increased mortality in COVID-19 patients. There are no validated lower airway biomarkers to predict clinical outcome. We investigated whether bacterial respiratory infections were associated with poor clinical outcome of COVID-19 in a prospective, observational cohort of 589 critically ill adults, all of whom required mechanical ventilation. For a subset of 142 patients who underwent bronchoscopy, we quantified SARS-CoV-2 viral load, analysed the lower respiratory tract microbiome using metagenomics and metatranscriptomics and profiled the host immune response. Acquisition of a hospital-acquired respiratory pathogen was not associated with fatal outcome. Poor clinical outcome was associated with lower airway enrichment with an oral commensal (Mycoplasma salivarium). Increased SARS-CoV-2 abundance, low anti-SARS-CoV-2 antibody response and a distinct host transcriptome profile of the lower airways were most predictive of mortality. Our data provide evidence that secondary respiratory infections do not drive mortality in COVID-19 and clinical management strategies should prioritize reducing viral replication and maximizing host responses to SARS-CoV-2., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

The term "giant cell myositis" has been used to refer to muscle diseases characterized histologically by multinucleated giant cells. Myasthenia gravis is an autoimmune neuromuscular junction disorder. The rare concurrence of giant cell myositis with myasthenia gravis has been reported; however, the clinical and histological features have varied widely. Here, we present such a case and a review of the literature. An 82-year-old woman admitted for subacute, progressive, proximal muscle weakness developed acute-onset dysphagia, dysphonia, and respiratory distress 5 days after admission. Laboratory findings were positive for acetylcholine receptor binding antibodies and striational muscle antibodies against titin. Muscle biopsy demonstrated widespread muscle fiber necrosis with multinucleated giant cells, consistent with giant cell myositis. She died despite treatment with pulse methylprednisolone and plasma exchange. A literature review of the PubMed and Scopus databases from 1944 to 2020 identified 15 additional cases of these co-existing diagnoses. We found that giant cell myositis with myasthenia gravis primarily affects female patients, is typically diagnosed in the 6-7th decades, and is characterized by the presence of thymoma. Muscle histology predominantly shows giant cell infiltrate without granulomas. The onset of myasthenia gravis symptoms may precede, follow, or coincide with symptoms of myositis. Treatment with thymectomy, anticholinesterase inhibitors, or immunosuppressive therapy may lead to favorable clinical outcomes., (© 2021. International League of Associations for Rheumatology (ILAR).)

Lung transplant is increasingly performed for the treatment of end-stage lung disease. As the number of lung transplants and transplant centers continues to rise, radiologists will more frequently participate in the care of patients undergoing lung transplant, both before and after transplant. Potential donors and recipients undergo chest radiography and CT as part of their pretransplant assessment to evaluate for contraindications to transplant and to aid in surgical planning. After transplant, recipients undergo imaging during the postoperative hospitalization and also in the long-term outpatient setting. Radiologists encounter a wide variety of conditions leading to end-stage lung disease and a myriad of posttransplant complications, some of which are unique to lung transplantation. Familiarity with these pathologic conditions, including their imaging findings and their temporal relationship to the transplant, is crucial to accurate radiologic interpretation. Knowledge of the surgical techniques and expected postoperative appearance prevents confusing normal posttransplant imaging findings with complications. A basic understanding of the indications, contraindications, and surgical considerations of lung transplant aids in imaging interpretation and protocoling and also facilitates communication between radiologists and transplant physicians. Despite medical and surgical advances over the past several decades, lung transplant recipients currently have an average posttransplant life expectancy of only 6.7 years. As members of the transplant team, radiologists can help maximize patient survival and hopefully increase posttransplant life expectancy and quality of life in the coming decades. © RSNA, 2021 An invited commentary by Bierhals is available online. Online supplemental material is available for this article .

Purpose: To compare GUM ButlerWeave Mint waxed floss, Reach Mint waxed floss and Oral-B Glide Pro-Health Original waxed floss for the tensile strength parameters, load and elongation, and for their ability to reduce artificial plaque. Also examined is the potential relationship between the tensile strength physical attributes and floss efficacy., Methods: For artificial plaque removal, floss products were placed around interproximal surfaces of artificial plaque-covered posterior-shaped teeth extending to a 60° angle. The testing apparatus moved the floss in a vertical direction to the tooth apex at two strokes per second with a 5 mm stroke for 15 seconds at a pressure of 150 g. The artificial plaque substrate was then evaluated for depth of artificial plaque removed (DPR) using a color comparison scale. Two tensile strength assays measuring maximum load and elongation also were conducted; the assays were based on the guidelines of the American Society for Testing and Materials. Twenty cm floss segments were pulled apart using a constant velocity, a load cell of 5 kN and a test speed of 1000 mm/minute until each floss segment broke apart. For each floss segment, the maximum load was measured in pounds and the elongation was measured in millimeters. Results for artificial plaque removal and tensile strength assays were statistically analyzed using the post hoc Tukey test for multiple pairwise comparisons and t-tests, assuming unequal variance, to compare the DPR, load, and elongation means., Results: In the artificial plaque removal assay, the mean DPR for GUM ButlerWeave Mint waxed floss was greater than the mean DPR for Reach Mint Waxed floss and Oral-B Glide Pro Health Original Waxed floss (P< 0.001). The mean DPR for Reach Mint waxed floss was also greater than Oral-B Glide Pro Health Original waxed floss mean DPR (P< 0.005). In the tensile strength load assay, both Oral-B Glide Pro Health Original waxed floss and GUM ButlerWeave Mint waxed floss had statistically higher means than Reach Mint waxed floss (P< 0.001 for each). There was no significant difference between the Oral-B Glide Pro Health and GUM ButlerWeave Mint waxed floss means (P> 0.05). In the elongation assay, the GUM ButlerWeave Mint waxed floss and Reach Mint waxed floss have statistically higher means than Oral-B Glide Pro Health floss (P< 0.001 for each). There was no statistically significant difference between the GUM ButlerWeave Mint waxed floss and Reach Mint waxed floss means (P> 0.05). In these laboratory assays there were no clear relationships, causal or otherwise, between artificial plaque removal and the testing tensile strength evaluations conducted., Clinical Significance: Dental plaque will result in the development of caries, gingivitis and periodontal disease if not removed regularly. The statistically higher efficacy of GUM ButlerWeave Mint waxed floss in decreasing artificial plaque depth, compared to two commercially available floss products that have demonstrated clinical efficacy in decreasing plaque and gingivitis, indicate that this product also may be effective for the treatment and reduction of plaque and related diseases., Competing Interests: Mr. Cwik, Ms. Spirgel, Dr. Shi and Dr. Yankell declared no conflict of interest. Mr. Gonzalez is an employee of Sunstar Americas Inc. Sunstar Americas, Inc. funded this research project., (Copyright©American Journal of Dentistry.)

Mortality among patients with COVID-19 and respiratory failure is high and there are no known lower airway biomarkers that predict clinical outcome. We investigated whether bacterial respiratory infections and viral load were associated with poor clinical outcome and host immune tone. We obtained bacterial and fungal culture data from 589 critically ill subjects with COVID-19 requiring mechanical ventilation. On a subset of the subjects that underwent bronchoscopy, we also quantified SARS-CoV-2 viral load, analyzed the microbiome of the lower airways by metagenome and metatranscriptome analyses and profiled the host immune response. We found that isolation of a hospital-acquired respiratory pathogen was not associated with fatal outcome. However, poor clinical outcome was associated with enrichment of the lower airway microbiota with an oral commensal ( Mycoplasma salivarium ), while high SARS-CoV-2 viral burden, poor anti-SARS-CoV-2 antibody response, together with a unique host transcriptome profile of the lower airways were most predictive of mortality. Collectively, these data support the hypothesis that 1) the extent of viral infectivity drives mortality in severe COVID-19, and therefore 2) clinical management strategies targeting viral replication and host responses to SARS-CoV-2 should be prioritized.

Importance: Decision-making in the timing of tracheostomy in patients with coronavirus disease 2019 (COVID-19) has centered on the intersection of long-standing debates on the benefits of early vs late tracheostomy, assumptions about timelines of infectivity of the novel coronavirus, and concern over risk to surgeons performing tracheostomy. Multiple consensus guidelines recommend avoiding or delaying tracheostomy, without evidence to indicate anticipated improvement in outcomes as a result., Objective: To assess outcomes from early tracheostomy in the airway management of patients with COVID-19 requiring mechanical ventilation., Design, Setting, and Participants: A retrospective medical record review was completed of 148 patients with reverse transcriptase-polymerase chain reaction-confirmed COVID-19 requiring mechanical ventilation at a single tertiary-care medical center in New York City from March 1 to May 7, 2020., Interventions: Open or percutaneous tracheostomy., Main Outcomes and Measures: The primary outcomes were time from symptom onset to (1) endotracheal intubation, (2) tracheostomy; time from endotracheal intubation to tracheostomy; time from tracheostomy to (1) tracheostomy tube downsizing, (2) decannulation; total time on mechanical ventilation; and total length of stay., Results: Participants included 148 patients, 120 men and 28 women, with an overall mean (SD) age of 58.1 (15.8) years. Mean (SD; median) time from symptom onset to intubation was 10.57 (6.58; 9) days; from symptom onset to tracheostomy, 22.76 (8.84; 21) days; and from endotracheal intubation to tracheostomy, 12.23 (6.82; 12) days. The mean (SD; median) time to discontinuation of mechanical ventilation was 33.49 (18.82; 27) days; from tracheostomy to first downsize, 23.02 (13.76; 19) days; and from tracheostomy to decannulation, 30.16 (16.00; 26) days. The mean (SD; median) length of stay for all patients was 51.29 (23.66; 45) days. Timing of tracheostomy was significantly associated with length of stay: median length of stay was 40 days in those who underwent early tracheostomy (within 10 days of endotracheal intubation) and 49 days in those who underwent late tracheostomy (median difference, -8; 95% CI, -15 to -1). In a competing risks model with death as the competing risk, the late tracheostomy group was 16% less likely to discontinue mechanical ventilation (hazard ratio, 0.84; 95% CI, 0.55 to 1.28)., Conclusions and Relevance: This cohort study from the first 2 months of the pandemic in New York City provides an opportunity to reconsider guidelines for tracheostomy for patients with COVID-19. Findings demonstrated noninferiority of early tracheostomy and challenges recommendations to categorically delay or avoid tracheostomy in this patient population. When aligned with emerging evidence about the timeline of infectivity of the novel coronavirus, this approach may optimize outcomes from tracheostomy while keeping clinicians safe.

Mortality among patients with COVID-19 and respiratory failure is high and there are no known lower airway biomarkers that predict clinical outcome. We investigated whether bacterial respiratory infections and viral load were associated with poor clinical outcome and host immune tone. We obtained bacterial and fungal culture data from 589 critically ill subjects with COVID-19 requiring mechanical ventilation. On a subset of the subjects that underwent bronchoscopy, we also quantified SARS-CoV-2 viral load, analyzed the microbiome of the lower airways by metagenome and metatranscriptome analyses and profiled the host immune response. We found that isolation of a hospital-acquired respiratory pathogen was not associated with fatal outcome. However, poor clinical outcome was associated with enrichment of the lower airway microbiota with an oral commensal ( Mycoplasma salivarium ), while high SARS-CoV-2 viral burden, poor anti-SARS-CoV-2 antibody response, together with a unique host transcriptome profile of the lower airways were most predictive of mortality. Collectively, these data support the hypothesis that 1) the extent of viral infectivity drives mortality in severe COVID-19, and therefore 2) clinical management strategies targeting viral replication and host responses to SARS-CoV-2 should be prioritized.

Using a longitudinal design, we examined whether event-related brain potentials (ERPs) correlates of successful episodic memory retrieval varied over a 4-year period according to the level of memory change. ERPs were recorded while participants performed a word-stem cued-recall task, and this procedure was repeated 4 years later. We compared the ERP old/new effect patterns of participants whose memory performance remained stable over time (stable group) with those of participants experiencing episodic memory decline (decline group). The pattern of change of the old/new effect differed between groups. At T1, the two groups exhibited the same pattern, with a positive frontal and parietal old/new effect. For the decline group, the old/new effect pattern did not change between T1 and T2. By contrast, for the stable group, the positive parietal old/new effect at T1 no longer appeared at T2, but a negative old/new effect was exhibited at frontal sites. This brain reorganization pattern could be a compensatory mechanism supporting strategic processes and allowing memory abilities to be maintained over time., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The lung allocation score (LAS) significantly improved outcomes and wait list mortality in lung transplantation. However, mortality remains high for the sickest wait list candidates despite additional changes to allocation distance. Regulatory considerations of overhauling the current lung allocation system have met significant resistance, and changes would require years to implement. This study evaluates whether a modest change to the current system by prioritization of only high-LAS lung transplant candidates would result in lowered wait list mortality., Methods: The Thoracic Simulated Allocation Model was used to evaluate all lung transplant candidates and donor lungs recovered between July 1, 2009 and June 30, 2011. Current lung allocation rules (initial offer within a 250-nautical mile radius for ABO-identical then compatible offers) were run. Allocation was then changed for only patients with an LAS of50 or higher (high-LAS) to be prioritized within a 500-nautical mile radius with no stratification between ABO-identical and compatible offers. Ten iterations of each model were run. Primary end points were wait list mortality and posttransplant 1-year survival., Results: A total of 6538 wait list candidates and transplant recipients were evaluated per iteration, for a total of 130,760 simulated patients. Compared with current allocation, the adjusted model had a 23.3% decrease in wait list mortality. Posttransplant 1-year survival was minimally affected., Conclusions: Without overhauling the entire system, simple prioritization changes to the allocation system for high-LAS candidates may lead to decreased wait list mortality and increased organ use. Importantly, these changes do not appear to lead to clinically significant changes in posttransplant 1-year survival., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Transition between primary and secondary school represents an important milestone in young people's development. While most young people look forward to this transition, it is a source of anxiety for many. Drawing on a nationally representative survey of 2218 children in 73 schools in Wales, this study aimed to understand the extent to which 10-11 year old children worried about and/or looked forward to their imminent transition to secondary school, the things they worried about and/or looked forward to, and how feelings about transition differed by socioeconomic status, as well as by emotional and behavioural difficulties. About a third of children reported being quite or very worried about transition to secondary school, while approximately two-thirds reported looking forward to it quite a bit or very much. These items were only moderately correlated, with many children both looking forward to and worrying about transition, or neither. Major sources of worry about transition centred around bullying and impact on existing friendships, while forming new friendships or joining existing friends in their new school were key things children looked forward to. Children from poorer backgrounds, attending poorer schools and reporting more emotional difficulties were significantly more likely to report worries about transition. Children from poorer families, and children reporting more emotional difficulties and behavioural difficulties, were less likely to look forward to transition. Interventions to support children in transition to secondary school need to be sensitive to the needs of children from poorer backgrounds and children with mental health difficulties., (© The Author(s) 2021.)

Background: The movement to advance academic preparation of entry-level nurses to the baccalaureate degree across the United States (U.S.) prompted the emergence of collaborative academic progression models. Since the National Academy of Medicine's (2010) call to action, nine states responded with academic progression collaboration models of nursing education to address the nursing shortage and prepare nurses for the increase in healthcare complexity., Purpose: The purpose of this scoping review is to examine key features including best practices and lessons learned of academic progression initiatives in nine states: California, Hawaii, Massachusetts, Montana, New Mexico, New York, North Carolina, Texas, and Washington. States that established academic progression models later are also included in this review., Methods: The Joanna Briggs Institute (JBI) procedures for scoping review were implemented to synthesize literature from multiple relevant sources including peer-reviewed journals and gray literature., Results: Best practices of academic progression models include local collaboration between academic institutions and program policy such as articulation agreements, seamless progression, and course transfer. Lessons learned include dissonance in faculty advising, employer support, and a paucity of data for robust program evaluation., Conclusions: Academic progression models that not only remove barriers for students to attain the BSN degree but also facilitate collaboration and innovative learning demonstrate success in promoting meaningful academic progression and education mobility., (Copyright © 2020 Elsevier Inc. All rights reserved.)

We conducted a retrospective review of thoracic transplant recipients (22 heart and 16 lung transplant recipients) prospectively enrolled in a single-center observational study of HCV NAT+ organ transplantation in HCV NAT- recipients. All recipients were treated with 8 weeks of glecaprevir-pibrentasvir (GP) for HCV viremia in addition to standard triple immunosuppression post-transplant. Thoracic transplant recipients of HCV NAT- organs were used as a control (24 heart and 22 lung transplant recipients). Our primary outcome was to assess the effect of GP on tacrolimus dose requirements. Secondary objectives included assessing drug interactions with common post-transplant medications, adverse effects, and the need to hold or discontinue GP therapy. The median tacrolimus concentration-to-dose ratio (CDR) in the cohort was 184 (99-260) during GP therapy and 154 (78-304) over the first month after GP (P = .79). Trends in median tacrolimus CDR were similar on a per-week basis and per-patient basis. In three instances, concomitant posaconazole and GP led to hyperbilirubinemia and interruption of posaconazole. GP therapy was held in one heart transplant recipient and discontinued in another due to unresolving hyperbilirubinemia. Utilization of GP to treat HCV viremia post-thoracic transplant is feasible and safe, but requires modifications to post-transplant pharmacotherapy and careful monitoring for adverse effects., (© 2020 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

Background: The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing, and technique while minimizing the risk of infection to health care workers (HCWs)., Methods: A panel including intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing patients with COVID-19 across a spectrum of health-care environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidence-based consensus statement and expert panel report., Results: Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health-care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19-related respiratory failure., Conclusion: This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat reverse transcription polymerase chain reaction testing in patients with confirmed COVID-19 evaluated for tracheostomy. To reduce the risk of infection in HCWs, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment. The recommendations presented in this statement may change as more experience is gained during this pandemic., (Copyright © 2020. Published by Elsevier Inc.)

Background: Coronavirus 2019 (COVID-19) is a worldwide pandemic, with many patients requiring prolonged mechanical ventilation. Tracheostomy is not recommended by current guidelines as it is considered a superspreading event owing to aerosolization that unduly risks health care workers., Methods: Patients with severe COVID-19 who were on mechanical ventilation for 5 days or longer were evaluated for percutaneous dilational tracheostomy. We developed a novel percutaneous tracheostomy technique that placed the bronchoscope alongside the endotracheal tube, not inside it. That improved visualization during the procedure and continued standard mechanical ventilation after positioning the inflated endotracheal tube cuff in the distal trachea. This technique offers a significant mitigation for the risk of virus aerosolization during the procedure., Results: From March 10 to April 15, 2020, 270 patients with COVID-19 required invasive mechanical ventilation at New York University Langone Health Manhattan's campus; of those, 98 patients underwent percutaneous dilational tracheostomy. The mean time from intubation to the procedure was 10.6 ± 5 days. Currently, 32 patients (33%) do not require mechanical ventilatory support, 19 (19%) have their tracheostomy tube downsized, and 8 (8%) were decannulated. Forty patients (41%) remain on full ventilator support, and 19 (19%) are weaning from mechanical ventilation. Seven patients (7%) died as a result of respiratory and multiorgan failure. Tracheostomy-related bleeding was the most common complication (5 patients). None of health care providers has had symptoms or tested positive for COVID-19., Conclusions: Our percutaneous tracheostomy technique appears to be safe and effective for COVID-19 patients and safe for health care workers., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Experimentation with e-cigarettes has grown rapidly among UK adolescents. To date, this topic has been primarily researched in secondary schools, with less understanding of development of attitudes and behaviours at an earlier age. This research reports qualitative data from interviews with pupils, parents, and teachers at 4 case study schools in Wales (N = 42). It draws on Bronfenbrenner's Ecological Systems Theory to consider how the intersection of systems surrounding primary school-age children and their interaction with these systems, shape knowledge, and attitudes towards e-cigarettes and tobacco. Findings indicate that consistent messaging on smoking from school and family was reflected in strong disapproval among pupils and clear understanding of harms. This was less evident for e-cigarettes, where messages were mixed and inconsistent between home and school, with concerns over what to tell children about e-cigarettes in light of mixed messages and absence of official guidance. Implications of findings for policy and teaching are discussed., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Control and representation (Craik & Bialystok, 2006, 2008) could be considered as potential cognitive resources playing a protective role against age-related memory decline. The main objective of this study was to explore whether the protective role (passive vs. active) associated with these resources varies according to the characteristics of the memory task. Young and older adults' memory performance was assessed using a cued-recall and a recognition task. Control and representation were measured, using the Excluded Letter Fluency Test and the Mill Hill vocabulary test, respectively. The results revealed that both control and representation had a significant positive impact on performance in both memory tasks. However, in the cued-recall task, age interacted only with control and not with representation level. Memory performance in this task was correlated with the control measure only for the older adults, indicating that memory decline in this task is moderated by control level. By contrast, for the recognition task, results showed that age interacted only with representation, indicating that the association between representation and recognition performance was greater for the older than the younger adults. This suggests that age-related recognition decline is moderated by representation level. These results suggest that the role played by both control and representation as protective resources against age-related memory decline depends on the task features; control would have an active protective role for cued-recall tasks, which involve more self-initiated and strategic processes, whereas representation would play this active protective role in a recognition task, which is heavily dependent upon semantic processes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Implementing uncontrolled donation after circulatory determination of death (uDCDD) in the United States could markedly improve supply of donor lungs for patients in need of transplants. Evidence from US pilot programs suggests families support uDCDD, but only if they are asked permission for using invasive organ preservation procedures prior to initiation. However, non-invasive strategies that confine oxygenation to lungs may be applicable to the overwhelming majority of potential uDCDD donors that have airway devices in place as part of standard resuscitation. We propose an ethical framework for lung uDCDD by: (a) initiating post mortem preservation without requiring prior permission to protect the opportunity for donation until an authorized party can be found; (b) using non-invasive strategies that confine oxygenation to lungs; and (c) maintaining strict separation between the healthcare team and the organ preservation team. Attempting uDCDD in this way has great potential to obtain more transplantable lungs while respecting donor autonomy and family wishes, securing public support, and enabling authorized persons to affirm or cease preservation decisions without requiring evidence of prior organ donation intent. It ensures prioritization of life-saving, the opportunity to allow willing donors to donate, and respect for bodily integrity while adhering to current ethical norms., (© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)