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OBJECTIVES: Veteran persons living with dementia (PLWDs) have high acute careutilization. We aim to understand why PLWDs seek care in the emergency department (ED) and how their utilization differs from older Veterans with no dementia diagnosis. We demonstrate the use of a novel national chief complaint data set in the Veteran Affairs Health Care System. METHODS: This was a retrospective observational study of ED users 65 years or older as of FY2017. The primary outcome is presence of one or more ED visits in FYs 2017–2018 using a logistic regression model controlling for dementia and other variables. Secondary outcomes include counts of ED visits by disposition, Emergency Severity Index, chief complaints defined by a natural language processing program, and ED encounter diagnoses defined by primary International Statistical Classification of Diseases, Tenth Revision (ICD-10-CM) code. RESULTS: Our cohort of Veterans comprised 3,115,263 patients. Of those, 255,372 (8.2%) had a diagnosis of dementia. Logistic regression modeling demonstrated that dementia is a significant predictor of ED use (p < 0.0001), with PLWDs more likely to have an ED visit (odds ratio 1.96, 95% confidence interval 1.94–1.98). PLWDs were admitted at higher rates when accounting for age and acuity. Chief complaints that were more common among PLWDs included falls (6.7% dementia vs. 3.3% without dementia), weakness (3.6% vs. 2.2%), and abnormal mental state (2.2% vs. 0.4%). ICD-10-CM codes were largely similar between the two groups. CONCLUSIONS: Our results reinforce that the ED is a common access point for Veterans with dementia. These patients require special consideration as they are more likely to visit the ED and be admitted. Our use of a novel national chief complaint data set suggests that they more commonly present with certain geriatric syndromes and nonspecific complaints. Further work is needed to determine whether these would warrant targeted interventions to improve quality of acute care.

As a clinician, everyone undergoes a difficult time in clinical decision-making when attempting to apply a clinical prediction rule for manipulation (Flynn et al., 2002; Childs et al., 2004) to a patient with a history and physical examination consistent with clinical lumbar instability (Hicks et al., 2005). The effect on neural pathways associated with manipulation has been suggested as one possible mechanism that may improve muscle performance (Pickar, 2002) and patient symptoms. Support exists for an association between spinal manipulation and improved muscle function in the quadriceps (Suter et al., 1999), the erector spinae (Keller and Colloca, 2000), and the deep neck flexors (Sterling et al., 2001). Therefore, it is reasonable to hypothesize that spinal manipulation, by a reflexogenic mechanism, may improve the performance of the deep trunk stabilizers. In turn, improved relaxation and contractility of the lumbar multifidus and the transversus abdominis (TrA) theoretically could lead to improved functional stability of the spine through enhancement of the neurological and active subsystems as defined by Panjabi (1992a, b). This single case study describes changes observed in the TrA musculature pre- to post-manipulation in a patient that presented with a clinical paradox (symptoms suggestive of clinical lumbar instability but also meeting the clinical prediction rule to succeed with lumbar manipulation therapy). Real-time ultrasound imaging (USI) was used to describe the changes in the TrA musculature..

Background of the study: Migraine is a renowned medical condition in 15% of general population. The patients with migraine exhibited active Trigger Points in their neck extensor muscles. Dry needling is a treatment using a thin filament sterile needle to puncture skin and create tiny lesions in a muscle, tendon, to help restore normal physiology function, and reduce pain. Needling has applications for myofascial pain, chronic pain, headache, migraine. Cervical Manipulation Technique has been used to reduce pain and improve range of motion and used in the treatment of patients with head and neck disorders, including neck pain and stiffness, muscle-tension headache, and migraine. The aim of this study is to compare the effectiveness of dry needling technique versus cervical manipulation technique on patients with migraine. Methodology: 30 patients were randomly divided into two groups; fifteen patients in the experimental group-A received cervical manipulation technique (3 times/week) and fifteen patients in the experimental group-B received Dry needling technique. The VAS and NDI were used as outcome measures. Result: Comparing between Group A and Group B showed significant difference in effectiveness on pain and Neck disability with P value >0.0001 among patients with migraine. Group B with Dry needling technique found more effective than Group A with cervical manipulation technique with mean difference of (2.867) and (11.40) over (2.267) and (10.47) respectively. Conclusion: Dry needling technique group is more effective over cervical manipulation technique on enhancing on pain and neck disability. Therefore, this study concludes that Dry needling technique is an effective intervention for migraine patients. Key words: Visual analog scale, Neck disability index, cervical manipulation technique, Dry needling technique, Trigger points.

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland caused by progressive hyperplasia, or abnormal growth of cells of the glandular epithelial and stromal cells. Globally, it has been documented that more than 80% of men by the age of 80 will suffer from BPH. Most men are hesitant to undergo surgical interventions for fear of losing potency and the perception of other adverse side effects. Effectto® is a polyherbal formulation designed by Vasu Research Center to be used for the treatment of BPH. It can also be indicated that it can be used for lower urinary tract symptoms and bladder outlet obstruction. The formulation is expected to provide significant BPH relief. The present study was planned to evaluate the effect of a polyherbal formulation on testosterone- and citral-induced Prostatic Hyperplasia. The activity of the polyherbal formulation for BPH was evaluated using testosterone depot injection as the inducing agent in a testosterone-induced model and citral-induced model for the atypical type of BPH in rats. Also, the acute toxicity study was done using OECD 423 guidelines to check the toxicity of the test compound. Data are expressed as mean ± SD and statistical significance was evaluated using one way ANOVA followed by Tukey’s multiple comparison tests. The polyherbal formulation was found to be safe at oral doses of 2000 mg/kg. Effectto® significantly decreased the weight of the prostate in the testosterone model as well as the citral model in rats. The effect on biochemical markers like serum PSA and TNF-α was also seen in both the cases. In particular serum PSA, the decrease was majorly significant in both the models when XIII compared. The formulation was able to reverse the effect of inducing agents on the prostate’s size.

Circadian clocks are built-in, self-maintaining timekeeping systems that allow organisms to predict changes in their environment and adjust their behaviour and physiology accordingly (Morse and Sassone-Corsi, 2002). Losing circadian clocks is bad for organisms because it makes them less likely to reproduce and live longer in controlled lab settings and less likely to survive in the wild (Vaze et al 2014). Disruptions in the circadian system can throw biological and behavioural cycles out of sync, which can have severe consequences for human health (Bedrosian and Nelson, 2017). This paper offers an in-depth review of the concept of circadian rhythm, the effect of disruption on human systems and diseases linked to such disruption, such as cancer, immunodeciency, sleep disorders, metabolic and cardiovascular system disorders, mental and health problems. It specically focuses on the adverse impact of disruption in circadian rhythm on the female reproductive system in the form of infertility, ovulatory disturbances, frequent miscarriages, birth defects and breast carcinoma. It also discusses some interventions that can be used to mitigate disruptions in circadian rhythm, based on the existing research. This paper adds to the existing literature on impact of circadian rhythm, especially on issues related to female reproductive health and is a useful resource for students, researchers and medical practitioners.

Cosmetic and laser procedures are increasingly popular among patients and are skills in which dermatologists are regarded as well trained. Most dermatology residents intend to incorporate cosmetic procedures into their practice and prefer to learn such procedures during residency through direct patient care. However, there are notable challenges in optimizing how residents are trained in cosmetic and laser dermatology. To address these barriers and elevate the practice of cosmetic dermatology in academic medicine, the Association of Academic Cosmetic Dermatology (AACD) was founded in 2021 as the lead professional society for dermatologists who direct the education of resident trainees in cosmetic and laser dermatology. The AACD,a group of board-certified dermatologists who teach cosmetic and laser dermatology to residents, aims to improve cosmetic dermatology education through collaboration, research, and advocacy.

BackgroundSince the onset of the COVID-19 pandemic, telehealth has been an option for Veterans receiving urgent care through Veterans Health Administration Community Care (CC).ObjectiveWe assessed use, arrangements, Veteran decision-making, and experiences with CC urgent care delivered via telehealth.DesignConvergent parallel mixed methods, combining multivariable regression analyses of claims data with semistructured Veteran interviews.SubjectsVeterans residing in the Western United States and Hawaii, with CC urgent care claims March 1 to September 30, 2020.Key resultsIn comparison to having in-person only visits, having a telehealth-only visit was more likely for Veterans who were non-Hispanic Black, were urban-dwelling, lived further from the clinic used, had a COVID-related visit, and did not require an in-person procedure. Predictors of having both telehealth and in-person (compared with in-person only) visits were other (non-White, non-Black) non-Hispanic race/ethnicity, urban-dwelling status, living further from the clinic used, and having had a COVID-related visit. Care arrangements varied widely; telephone-only care was common. Veteran decisions about using telehealth were driven by limitations in in-person care availability and COVID-related concerns. Veterans receiving care via telehealth generally reported high satisfaction.ConclusionsCC urgent care via telehealth played an important role in providing Veterans with care access early in the COVID-19 pandemic. Use of telehealth differed by Veteran characteristics; lack of in-person care availability was a driver. Future work should assess for changes in telehealth use with pandemic progression, geographic differences, and impact on care quality, care coordination, outcomes, and costs to ensure Veterans' optimal and equitable access to care.

Understanding the role of therapeutic process factors in treatment change may prove useful for discerning why some autistic youth benefit from psychosocial interventions that target emotional and psychological aspects of mental health, while others do not. The aim of the current study was to synthesize what is currently known about therapeutic process factors in mental health treatment of emotional and psychological challenges for autistic youth, regarding how process factors have been measured in past research, and the relation between process factors and treatment outcome. A systematic review of the literature was conducted to narratively synthesize all articles published up until June 2021. Methodological quality of included studies was appraised. Twenty-five studies met inclusion criteria. Process factors assessed across studies included relational factors; treatment expectations, readiness, and satisfaction; and treatment engagement from youth and their parents. Process-outcome associations were reported for a limited number of constructs. There is a limited, albeit growing, body of high-quality research evaluating the role of process factors in the treatment of mental health issues for autistic youth. Future research should continue to examine process factors in relation to treatment outcome, and validate measures to accurately capture process-related constructs in mental health treatment for this population. Greater understanding of therapy processes can lead to developing evidence-informed strategies that clinicians can implement to promote positive expectations, relationships, and engagement.

Pityriasis lichenoides is an acute and/or chronic skin disease associated with recurrent erythematous papules that self-resolve. While its etiology is unknown, preceding viral infection may play a role. We present an atypical case of a 40-year-old woman with pityriasis lichenoides et varioliformis acuta as a complication of a COVID-19 infection.

The inhibitive effect of N, N-Dimethylaniline (DMA) as corrosion inhibitor for zinc in 0.1, 0.3 and 0.5 M H2SO4solutions has been investigated by using weight loss, potentiodynamic polarization and electrochemical impedance spectroscopy (EIS) techniques. The results obtained reveal that inhibition efficiency (I.E.) increases with increase in concentration of inhibitors but decreases with increase in temperature. As inhibitor concentration increases corrosion rate decreases. The rate constant ‘k’ decreases while half-life ‘t½’ increases with the increase in concentration of inhibitor. DMA showed maximum I. E. of 93.51 % at 60 mM in 0.5 M H2SO4acid at 301 K. The inhibition effect is discussed in view of DMA molecules adsorbed on the metal surface and it obeys Langmuir adsorption isotherm. Polarization curve indicates that inhibitor act as mixed type for zinc corrosion in sulphuric acid solutions.

BackgroundMost analyses of excess mortality during the COVID-19 pandemic have employed aggregate data. Individual-level data from the largest integrated healthcare system in the US may enhance understanding of excess mortality.MethodsWe performed an observational cohort study following patients receiving care from the Department of Veterans Affairs (VA) between 1 March 2018 and 28 February 2022. We estimated excess mortality on an absolute scale (i.e., excess mortality rates, number of excess deaths), and a relative scale by measuring the hazard ratio (HR) for mortality comparing pandemic and pre-pandemic periods, overall, and within demographic and clinical subgroups. Comorbidity burden and frailty were measured using the Charlson Comorbidity Index and Veterans Aging Cohort Study Index, respectively.ResultsOf 5,905,747 patients, median age was 65.8 years and 91% were men. Overall, the excess mortality rate was 10.0 deaths/1000 person-years (PY), with a total of 103,164 excess deaths and pandemic HR of 1.25 (95% CI 1.25-1.26). Excess mortality rates were highest among the most frail patients (52.0/1000 PY) and those with the highest comorbidity burden (16.3/1000 PY). However, the largest relative mortality increases were observed among the least frail (HR 1.31, 95% CI 1.30-1.32) and those with the lowest comorbidity burden (HR 1.44, 95% CI 1.43-1.46).ConclusionsIndividual-level data offered crucial clinical and operational insights into US excess mortality patterns during the COVID-19 pandemic. Notable differences emerged among clinical risk groups, emphasising the need for reporting excess mortality in both absolute and relative terms to inform resource allocation in future outbreaks.KEY MESSAGESMost analyses of excess mortality during the COVID-19 pandemic have focused on evaluations of aggregate data, which may miss important individual-level drivers of excess mortality that may serve as future targets for improvement initiatives.Using individual-level data from a national integrated healthcare system, we estimated absolute and relative excess mortality and number of excess deaths overall and within demographic and clinical subgroups.Absolute rates of excess mortality were typically highest in groups where the baseline rate of mortality was higher; namely in older age groups and among those with more comorbidities and higher levels of physiologic frailty.Relative measures of excess mortality were typically greatest among younger age groups and among those with lower physiologic frailty and fewer comorbidities.Relative measures of excess mortality attenuated but remained elevated after censoring follow-up at first documented SARS-CoV-2 infection or COVID-19, suggesting that factors beyond SARS-CoV-2 infection contributed to the observed excess mortality during the pandemic.

This pilot study examined associations between transdiagnostic symptoms and parent-perceived parent-child relationship quality in treatment-seeking families of children with neurodevelopmental disabilities, and interactions among clinical symptoms and cognitive functioning. Sixty-three children between 8 to 13 years of age and their caregivers were assessed at baseline while seeking cognitive behaviour therapy for emotion regulation and mental health difficulties. Diagnoses included autism, ADHD, cerebral palsy, and learning disability, with 52% of children having multiple diagnoses. Parent-perceived parent-child relationship quality was assessed by the Positive Affect Index, autism symptoms (e.g., social communication, repetitive behaviours) by the Social Responsiveness Scale, Second Edition, mental health (i.e., internalizing problems, externalizing problems, behavioural symptoms) by the Behaviour Assessment Scale for Children, Third Edition, and IQ by the Weschler Abbreviated Scale of Intelligence, Second Edition. Results revealed that higher IQ scores and greater social communication challenges, externalizing problems, and behavioural symptoms, were associated with lower parent-child relationship quality. Interaction effects were found between IQ and social communication challenges, reflecting significantly stronger relationships between social communication challenges and lower parent-child relationship quality in the context of higher IQ. Understanding the interactions between cognitive functioning and social communication challenges can help to inform individualized supports, and advocate for a transdiagnostic approach to intervention.

Histone deacetylases 1 and 2 (HDAC1/2) serve as the catalytic subunit of six distinct families of nuclear complexes. These complexes repress gene transcription through removing acetyl groups from lysine residues in histone tails. In addition to the deacetylase subunit, these complexes typically contain transcription factor and/or chromatin binding activities. The MIER:HDAC complex has hitherto been poorly characterized. Here, we show that MIER1 unexpectedly co-purifies with an H2A:H2B histone dimer. We show that MIER1 is also able to bind a complete histone octamer. Intriguingly, we found that a larger MIER1:HDAC1:BAHD1:C1QBP complex additionally co-purifies with an intact nucleosome on which H3K27 is either di- or tri-methylated. Together this suggests that the MIER1 complex acts downstream of PRC2 to expand regions of repressed chromatin and could potentially deposit histone octamer onto nucleosome-depleted regions of DNA.

Female physicians in academic medicine have faced barriers that potentially affect representation in different fields and delay promotion. Little is known about gender representation differences in United States academic radiology departments, particularly within the most pursued subspecialties.To determine whether gender differences exist in United States academic radiology departments across seven subspecialties with respect to academic ranks, departmental leadership positions, experience, and scholarly metrics.In this cross-sectional study from November 2018 to June 2020, a database of United States academic radiologists at 129 academic departments in seven subspecialties was created. Each radiologist's academic rank, departmental leadership position (executive-level - Chair, Director, Chief, and Department or Division Head vs vice-level - vice, assistant, or associate positions of executive level), self-identified gender, years in practice, and measures of scholarly productivity (number of publications, citations, and h-index) were compiled from institutional websites, Doximity, LinkedIn, Scopus, and official NPI profiles. The primary outcome, gender composition differences in these cohorts, was analyzed using ChiOverall, 5086 academic radiologists (34.7% women) with a median 14 years of practice (YOP) were identified and indexed. There were 919 full professors (26.1% women, p0.01) and 1055 executive-level leadership faculty (30.6% women, p0.01). Within all subspecialties except breast imaging, women were in the minority (35.4% abdominal, 79.1% breast, 12.1% interventional, 27.5% musculoskeletal, 22.8% neuroradiology, 45.1% pediatric, and 19.5% nuclear; p0.01). Relative to subspecialty gender composition, women full professors were underrepresented in abdominal, pediatric, and nuclear radiology (p0.05) and women in any executive-level leadership were underrepresented in abdominal and nuclear radiology (p0.05). However, after adjusting for h-index and YOP, gender did not influence rates of professorship or executive leadership. The strongest single predictors for professorship or executive leadership were h-index and YOP.Women academic radiologists in the United States are underrepresented among senior faculty members despite having similar levels of experience as men. Gender disparities regarding the expected number of women senior faculty members relative to individual subspecialty gender composition were more pronounced in abdominal and nuclear radiology, and less pronounced in breast and neuroradiology. Overall, h-index and YOP were the strongest predictors for full-professorship and executive leadership among faculty.● Though women comprise 34.7% of all academic radiologists, women are underrepresented among senior faculty members (26.1% of full professors and 30.6% of executive leadership) ● Women in junior faculty positions had higher median years of practice than their male counterparts (10 vs 8 for assistant professors, 21 vs 13 for vice leadership) ● Years of practice and h-index were the strongest predictors for full professorship and executive leadership.

Aniline corrosion inhibitor effect on zinc in a H2SO4 solution has been evaluated by weight loss (WL), potentiodynamic polarization (PDP), electrochemical impedance spectroscopy (EIS) and Scanning Electron Microscope (SEM) techniques. The corrosion rate increased with higher acid concentrations. At constant inhibitor content, with higher acid concentrations, the corrosion rate increased. With higher inhibitor concentrations the corrosion rate decreased, while inhibition efficiency (IE) percentage increased. The maximum IE of 90.18% was obtained at 60 mM of aniline in a 0.5 M H2SO4 solution. Polarization studies revealed that aniline acts as a mixed type inhibitor. EIS spectra are semicircular, which indicates that zinc corrosion was mainly controlled by a charge transfer process. SEM reveals the appearance of a smooth surface on zinc in aniline presence, probably due to the formation of an adsorptive film of electrostatic character. It was found that there is a good agreement between the different tested techniques.

The transmembrane protein Axl was proposed as an entry receptor for Zika virus (ZIKV) infection in vitro, but conflicting results from in vivo studies have made it difficult to establish Axl as a physiologically relevant ZIKV receptor. Both the functional redundancy of receptors and the experimental model used can lead to variable results. Therefore, it can be informative to explore alternative animal models to analyze ZIKV receptor candidates as an aid in discovering antivirals. This study used chicken embryos to examine the role of chicken Tyro3 (cTyro3), the equivalent of human Axl. Results show that endogenous cTyro3 mRNA expression overlaps with previously described hot spots of ZIKV infectivity in the brain and inner ear. We asked if ectopic expression or knockdown of cTyro3 influenced ZIKV infection in embryos. Tol2 vectors or replication-competent avian retroviruses were used in ovo to introduce full-length or truncated (presumed dominant-negative) cTyro3, respectively, into the neural tube on embryonic day two (E2). ZIKV was delivered to the brain 24 h later. cTyro3 manipulations did not alter ZIKV infection or cell death in the E5/E6 brain. Moreover, delivery of truncated cTyro3 variants to the E3 otocyst had no effect on inner ear formation on E6 or E10.

The American College of Rheumatology guidelines provides a strong recommendation for the use of biologic disease-modifying antirheumatic drugs (bDMARDs) when conventional rheumatoid arthritis treatments fail to meet treatment targets. Although bDMARDs are an effective and important treatment component, access inequalities remain a challenge in many communities worldwide. The purpose of this analysis is to assess nationwide trends in bDMARD access in the United States, with a specific focus on rural and urban access gaps. This study combined multiple county-level databases to assess bDMARD prescriptions from 2015 to 2019. Using geospatial analysis and the Moran's I statistic, counties were classified according to prescription levels to assess for hotspots and coldspots. Analysis of variance (ANOVA) was used to compare significant counties across 49 socioeconomic variables of interest. The analysis identified statistically significant hotspot and coldspot prescription clusters within the United States. Coldspot (Low-Low) clusters with low access to bDMARDs are located predominantly in the rural west North Central region, extending down to Oklahoma and Arkansas. Hotspot (High-High) clusters are seen in urban and metro areas of Wisconsin, Minnesota, Pennsylvania, North Carolina, Georgia, Oregon, and the southern tip of Texas. Comparing coldspot to hotspot areas of bDMARD access revealed that the Medicare populations were older, more rural, less educated, less impoverished, and less likely to get their bDMARDs from a rheumatologist.

Background The medical community continues to seek to understand both the causes and consequences of opioid use disorder (OUD). The recent 2019 public release of the Automation of Reports and Consolidated Orders System (ARCOS) database from the years 2006 to 2012 provides a unique opportunity to analyze a critical period of the opioid epidemic with unprecedented data granularity. Objectives This study aims to use the ARCOS dataset to (1) determine significant contributory variables to opioid overdose death rates, (2) determine significant contributory variables to the relative prescription of buprenorphine and methadone, and (3) evaluate the existence of statistically significant geospatial clusters in buprenorphine and methadone prescription rates. Methods This study utilizes multiple databases, including the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER), the Drug Enforcement Administration (DEA) prescription drug data, and the United States (US) Census demographics, to examine the relationship between the different treatments of OUD. Linear regressions are used to determine significant contributory factors in overdose rate and the buprenorphine-to-methadone ratio. Geospatial analysis is used to identify geographic clusters in opioid overdoses and treatment patterns. Results Methadone prescriptions, racial demographics, and poverty were found to significantly correspond to opioid overdose death rates (p0.05). Buprenorphine prescriptions were not found to be significant (p = 0.20). Opioid overdoses, metro character, racial categorization, and education were found to significantly correspond to the ratio of buprenorphine to methadone prescribed (p0.05). Cluster analysis demonstrated different geospatial distributions in the prescriptions of buprenorphine and methadone (p0.05). Conclusion Historically, methadone prescriptions have been higher in areas with high overdose rates. Buprenorphine and methadone prescribing patterns have historically demonstrated different geographic trends.

Cosmetic dermatology is a key subspecialty of academic dermatology. As such, academic centers are expected to demonstrate excellence in the teaching of cosmetic dermatology skills to trainees, the clinical delivery of cosmetic dermatology services to patients, and the performance of clinical research that advances knowledge and uncovers new therapies in cosmetic dermatology. The Association of Academic Cosmetic Dermatology (AACD), a newly formed medical professional society, includes as its principal aims the support of all of these areas. AACD is comprised of group of board-certified dermatologists who teach cosmetic and laser dermatology at US dermatology residency programs. An expert panel constituted by the AACD recently convened a workshop to review gaps pertaining to academic cosmetic dermatology. This panel considered needs and potential corrective initiatives in three domains: resident education, patient experience, and clinical research. The work of the panel was used to develop a roadmap, which was adopted by consensus, and which will serve to guide the AACD moving forward.

Cerebral Venous Sinus Thrombosis (CVST) remains a challenge to diagnose due to its rarity and nonspecific symptomatology. We have found alcohol withdrawal can display symptoms similar to CVST. We present a unique case of intraparenchymal hemorrhage secondary to an extensive CVST in a patient presenting with symptoms suggestive of alcohol withdrawal.A 33-year-old woman with a history of alcohol dependence presented with a worsening headache and right upper dental pain. She denied any trauma and attributed the headache to alcohol withdrawal. She denied consuming alcohol in the last 24 hours but reported a daily intake of 20 oz of whiskey. Physical examination noted dental caries and a normal neurological examination. Laboratory values indicated leukocytosis with neutrophilia and microcytic anemia. Computed tomography brain without contrast was conducted to rule out head trauma, revealing a 1.2 cm intraparenchymal hemorrhage in the left frontal lobe with local edema. Neurosurgery recommended a computed tomography angiography, which demonstrated contrast filling defects consistent with CVST (confirmed by magnetic resonance venography). The patient was admitted to the intensive care unit; during her hospital course, further testing revealed heterozygous methylenetetrahydrofolate reductase mutation and elevated homocysteine levels. Patient underwent acute treatment with enoxaparin bridged to apixaban. Patient was discharged on day 7 neurologically intact with the improvement of all symptoms.This unique presentation of CVST alongside alcohol withdrawal symptoms highlights the importance of recognizing atypical presentations of CVST in higher-risk patient populations. A heightened index of suspicion for the wide range of presentations of CVST is necessary to assess, diagnose, and treat at-risk patients.

Severe respiratory impairment is a prominent feature of Rett syndrome, an X-linked disorder caused by mutations in methyl CpG-binding protein 2 (MECP2). Despite MECP2’s ubiquitous expression, respiratory anomalies are attributed to neuronal dysfunction. Here, we show that neutral lipids accumulate in mouse Mecp2-mutant lungs, whereas surfactant phospholipids decrease. Conditional deletion of Mecp2 from lipid-producing alveolar epithelial 2 (AE2) cells causes aberrant lung lipids and respiratory symptoms, whereas deletion of Mecp2 from hindbrain neurons results in distinct respiratory abnormalities. Single-cell RNA sequencing of AE2 cells suggests lipid production and storage increase at the expense of phospholipid synthesis. Lipid production enzymes are confirmed as direct targets of MECP2-directed nuclear receptor co-repressor 1/2 transcriptional repression. Remarkably, lipid-lowering fluvastatin improves respiratory anomalies in Mecp2-mutant mice. These data implicate autonomous pulmonary loss of MECP2 in respiratory symptoms for the first time and have immediate impacts on patient care.

The repurposing of licenced drugs for use against COVID-19 is one of the most rapid ways to develop new and alternative therapeutic options to manage the ongoing pandemic. Given the approximately 8,000 licenced compounds available from Compounds Australia that can be screened, this paper demonstrates the utility of commercially-available ex vivo/3D airway and alveolar tissue models. These models are a closer representation of in vivo studies compared to in vitro models, but retain the benefits of rapid in vitro screening for drug efficacy. We demonstrate that several existing drugs appear to show anti-SARS-CoV-2 activity against both Delta and Omicron Variants of Concern in the airway model. In particular, fluvoxamine, as well as aprepitant, everolimus, and sirolimus have virus reduction efficacy comparable to the current standard of care (remdesivir, molnupiravir, nirmatrelvir). Whilst these results are encouraging, further testing and efficacy studies are required before clinical use can be considered.

ImportanceThe COVID-19 pandemic had a substantial impact on the overall rate of death in the United States during the first year. It is unclear whether access to comprehensive medical care, such as through the VA healthcare system, altered death rates compared to the US population.ObjectiveQuantify the increase in death rates during the first year of the COVID-19 pandemic in the general US population and among individuals who receive comprehensive medical care through the Department of Veterans Affairs (VA).DesignAnalysis of changes in all-cause death rates by quarter, stratified by age, sex race/ethnicity, and region, based on individual-level data. Hierarchical regression models were fit in a Bayesian setting. Standardized rates were used for comparison between populations.Setting and participantsGeneral population of the United States, enrollees in the VA, and active users of VA healthcare.Exposure and main outcomeChanges in rates of death from any cause during the COVID-19 pandemic in 2020 compared to previous years.ResultsSharp increases were apparent across all of the adult age groups (25 years and older) in both the general US population and the VA populations. Across all of 2020, the relative increase in death rates was similar in the general US population (RR: 1.20 (95% CI: 1.17, 1.22)), VA enrollees (RR: 1.20 (95% CI: 1.14, 1.29)), and VA active users (RR: 1.19 (95% CI: 1.14, 1.26)). Because the pre-pandemic standardized mortality rates were higher in the VA populations prior to the pandemic, the absolute rates of excess mortality were higher in the VA populations.Conclusions and RelevanceDespite access to comprehensive medical care, active users of the VA had similar relative mortality increases from all causes compared with the general US population. Factors that influenced baseline rates of death and that mitigated viral transmission in the community are more likely to have influenced the impact of the pandemic.

Understanding the role of therapeutic process factors in treatment change may prove useful for discerning why some autistic youth benefit from psychosocial interventions that target emotional and psychological aspects of mental health, while others do not. The aim of the current study was to synthesize what is currently known about therapeutic process factors in mental health treatment of emotional and psychological challenges for autistic youth, regarding how process factors have been measured in past research, and the relation between process factors and treatment outcome. A systematic review of the literature was conducted to narratively synthesize all articles published up until June 2021. Methodological quality of included studies was appraised. Twenty-five studies met inclusion criteria. Process factors assessed across studies included relational factors; treatment expectations, readiness, and satisfaction; and treatment engagement from youth and their parents. Process-outcome associations were reported for a limited number of constructs. There is a limited, albeit growing, body of high-quality research evaluating the role of process factors in the treatment of mental health issues for autistic youth. Future research should continue to examine process factors in relation to treatment outcome, and validate measures to accurately capture process-related constructs in mental health treatment for this population. Greater understanding of therapy processes can lead to developing evidence-informed strategies that clinicians can implement to promote positive expectations, relationships, and engagement.

Histone deacetylases 1 and 2 (HDAC1/2) serve as the catalytic subunit of six distinct families of nuclear complexes. These complexes repress gene transcription through removing acetyl groups from lysine residues in histone tails. In addition to the deacetylase subunit, these complexes typically contain transcription factor and/or chromatin binding activities. The MIER:HDAC complex has hitherto been poorly characterized. Here we show that MIER1 unexpectedly co-purifies with an H2A:H2B histone dimer. We show that MIER1 is also able to bind a complete histone octamer. Intriguingly, we found that a larger MIER1:HDAC1:BAHD1:C1QBP complex additionally co-purifies with an intact nucleosome on which H3K27 is either di- or tri-methylated. Together this suggests that the MIER1 complex acts downstream of PRC2 to expand regions of repressed chromatin and to deposit histone octamer onto nucleosome-depleted regions of DNA.

Lean management is a strategy for improving health care experiences of patients. While best practices for engaging patients in quality improvement have solidified in recent years, few reports specifically address patient engagement in Lean activities. This study examines the benefits and challenges of incorporating patient engagement strategies into the Veterans Health Administration's (VA) Lean transformation.: We conducted a multisite, mixed-methods evaluation of Lean deployment at 10 VA medical facilities, including 227 semistructured interviews with stakeholders, including patients.Interviewees noted that a patient-engaged Lean approach is mutually beneficial to patients and health care employees. Benefits included understanding the veteran's point of view, uncovering inefficient aspects of care processes, improved employee participation in Lean events, increased transparency, and improved reputation for the organization. Challenges included a need for focused time and resources to optimize veteran participation, difficulty recruiting a diverse group of veteran stakeholders, and a lack of specific instructions to encourage meaningful participation of veterans.As the first study to focus on patient engagement in Lean transformation efforts at the VA, this study highlights ways to effectively partner with patients in Lean-based improvement efforts. Lessons learned may also help optimize patient input into quality improvement more generally.

Ribosome-inactivating proteins (RIPs) are toxic N-glycosidases that depurinate eukaryotic and prokaryotic rRNAs and thus interrupt protein synthesis during translation. In the present study, a protein of around 32 kDa, supposedly a RIP isolated from Trichosanthes dioica, was assessed for its potential to induce apoptosis in HeLa cells. Cell viability assay was done to measure cell proliferation and survivability. It was observed that cells viability decreased with the increase of decrease in dilution, i.e. when the sample was an undiluted one, the viability decreased drastically and almost came to less than 10%. To further check whether the isolated RIP could induce apoptosis, HeLa cells were treated with the test RIP. Immunoblotting was carried out using PARP poly (ADP-ribose) polymerase (PARP-1), a 113 kDa nuclear enzyme, which is considered a hallmark of cells undergoing apoptosis. HeLa cells were further analyzed for loss of mitochondrial membrane potential with JC-1 dye, which is an early event during apoptosis. Increased PARP breakdown in the RIP treated cells indicates that cells undergoing apoptosis and progressive loss of red J-aggregate fluorescence indicate that the isolated RIP from Trichosanthes dioica induces apoptosis in HeLa cells. The ability of apoptosis induction is comparable to another known RIP from Momordica charantia, which was used as a positive control. Promising results from the present study warrants the isolated RIP to be further explored for anticancer activities.

Corrosion is the deterioration of metal by chemical attack or reaction with its environment. It is a constant and continuous problem, often difficult to eliminate completely. Prevention would be more practical and achievable than complete elimination. Recently, a huge interested for the use of naturally occurring inhibitors extracted from plants have been emerged. Most of the natural products are non-toxic, biodegradable and readily available due to environmental concerns. The inhibitor is chemically adsorbed on the surface of the metal and forms a protective thin film with inhibitor effect or by combination between inhibitor ions and metallic surface. Corrosion of copper and its inhibition was analyzed by weight loss (Gravimetric), effect of temperature and time of immersion methods. Electrochemical methods such as, Potentiodynamic polarization and Electrochemical Impedance Spectra (EIS) were employed. The protective films formed on metal surface have been analyzed by various techniques such as Scanning Electron Microscope (SEM), Energy dispersive X-ray spectrometry (EDS) and. Atomic Force Microscopy (AFM), Fourier transform infrared spectroscopy (FT-IR), UV-Visible spectra, X-ray Diffraction spectroscopy (XRD), Energy Dispersive X-ray Spectroscopy (EDX), electrochemical frequency modulation (EFM) techniques. The results obtained from weight loss and electrochemical techniques were in good agreement. In this review paper, research works produced over the past background on the corrosion of copper in various medium and their corrosion inhibition by using a various green inhibitors were presented.

The cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway has been primarily characterized as an inflammatory mechanism in higher eukaryotes in response to cytosolic double-stranded DNA (dsDNA). Since its initial discovery, detailed mechanisms delineating the dynamic subcellular localization of its different components and downstream signaling have been uncovered, leading to attempts to harness its proinflammatory properties for therapeutic benefit in cancer. Emerging evidence, however, indicates that a crucial primordial function of STING is to promote autophagy, and that downstream interferon (IFN) signaling emerged recently in its evolutionary history. Furthermore, studies suggest that this pathway is a crucial regulator of cellular metabolism that potentially couples inflammation to nutrient availability. We focus on the evolutionarily conserved functions of STING, and we discuss how a broader understanding of this pathway can help us to better appreciate its potential role in cancer and harness it for therapeutic benefit.

Introduction Under current regulations, there are three separate authorities for which the Veterans Health Administration (VHA) can pay for emergency medical care received by Veterans in the community. The three VHA authorities have overlapping criteria and eligibility requirements that contribute to a complex and confusing landscape for Veterans when they obtain emergency care in the community. Given the intricacies in how VHA provides coverage for community emergency care and the desire to provide seamless Veteran-centric care, it is imperative to understand Veterans’ experiences with navigating coverage for community emergency care. The purpose of this study was to elicit feedback from Veterans about their experiences with and perceptions of community emergency care coverage paid for by VHA. Materials and Methods Veterans Health Administration data were used to identify geographically diverse Veterans who recently used emergency care. We conducted semi-structured, qualitative interviews with 50 Veterans to understand their VHA coverage and experiences with accessing community emergency care. Interviews were audio recorded and transcribed verbatim. We conducted directed content analysis of interview transcripts. Results Veterans emphasized three major concerns with navigating community emergency care: (1) they lack information about benefits and eligibility when they need it most, (2) they require assistance with medical billing to avoid financial hardship and future delays in care, and (3) they desire multimodal communication about VHA policies or updates in emergency coverage. Conclusions Our results highlight the challenges Veterans experience in understanding VHA coverage for community emergency care. Feedback suggests that improving information, support, and communication may help Veterans make timely, informed decisions when experiencing unexpected illness or injury.