Search

Little research is available to provide practical guidance to health care providers for exercise preparticipation screening and referral of patients with interstitial lung diseases (ILDs), including lymphangioleiomyomatosis (LAM), to participate in remote, unsupervised exercise programs.

Patients admitted to the intensive care unit (ICU) following trauma often have multiple injuries, which can lead to disordered swallowing, dysphagia. The prevalence of dysphagia in trauma populations ranges between 4.2% and 86%; however, clinical and associated longitudinal health outcomes and patient-reported quality of life are unknown.

IMPORTANCE: Chronic skin disorders in children frequently are visible and can cause stigmatization. However, the extent of stigmatization from chronic skin disease and association with mental health needs further study. OBJECTIVE: To examine the extent of stigma, dependence on disease visibility and severity, and association with mental health and quality of life (QOL) in chronic pediatric skin disease. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, single-visit study was conducted at 32 pediatric dermatology centers in the US and Canada from November 14, 2018, to November 17, 2021. Participants included patients aged 8 to 17 years with chronic skin disease and 1 parent. MAIN OUTCOMES AND MEASURES: Using the Patient-Reported Outcomes Measurement Instrumentation System (PROMIS) Stigma-Skin, the extent of stigma with child-, caregiver-, and physician-assessed disease visibility (primary outcome) and severity was compared, as well as reduced QOL (assessed by Skindex-Teen), depression, anxiety, and poor peer relationships (PROMIS child and proxy tools) (secondary outcomes). RESULTS: The study included 1671 children (57.9% female; mean [SD] age, 13.7 [2.7] years). A total of 56.4% participants had self-reported high disease visibility and 50.5% had moderate disease severity. Stigma scores significantly differed by level of physician-assessed and child/proxy-assessed disease visibility and severity. Among children with chronic skin disorders, predominantly acne, atopic dermatitis, alopecia areata, and vitiligo, only 27.0% had T scores less than 40 (minimal or no stigma) and 43.8% had at least moderate stigma (T score ≥45) compared with children with a range of chronic diseases. Stigma scores correlated strongly with reduced QOL (Spearman ρ = 0.73), depression (ρ = 0.61), anxiety (ρ = 0.54), and poor peer relationships (ρ = −0.49). Overall, 29.4% of parents were aware of bullying of their child, which was strongly associated with stigma (Cohen d = −0.79, with children who were not bullied experiencing lower levels of stigma). Girls reported more stigma than boys (Cohen d = 0.26). Children with hyperhidrosis and hidradenitis suppurativa were most likely to have increased depression and anxiety. CONCLUSIONS AND RELEVANCE: The findings of this study suggest that physician assessment of disease severity and visibility is insufficient to evaluate the disease impact in the patient/caregiver. Identifying stigmatization, including bullying, and tracking improvement through medical and psychosocial interventions may be a key role for practitioners.

Palaeo Down Under3 (PDU3), the now quadrennial conference of the Australasian Palaeontologists(AAP) association, was held in Perth, Western Australia, from the 10th–14th of July 2023. PDU3 showcased innovative research, outreach and education initiatives being conducted across Australasia and beyond by both local and international scientists. A total of 78 talks, 17 posters and 6 plenaries were presented across the five days, and covered a wide range of topics, geological timeframes, and fossil groups. AAP is proud to publish this compilation of PDU3 abstracts to illustrate the current and ongoing strength of Australasian palaeontology.Sarah K. Martin [Sarah.Martin@dmirs.wa.gov.au], Geological Survey of Western Australia, Department of Energy, Mines, Industry Regulation and Safety, 100 Plain St, East Perth, Western Australia 6004, Australia; Michael Archer [m.archer@unsw.edu.au], School of Biological, Earth & Environmental Sciences, University of New South Wales, Sydney, New South Wales 2052, Australia; Heidi J. Allen [Heidi.allen@dmirs.wa.gov.au], Geological Survey of Western Australia, Department of Energy, Mines, Industry Regulation and Safety, 100 Plain St, East Perth, Western Australia 6004, Australia; Daniel D. Badea [badeadaniel.i13@gmail.com], Faculty of Geography and Geology, “Alexandru Ioan Cuza” University, Bulevard “Carol I”, Nr.11, 707006, Iași, Romania; Eleanor Beidatsch [ebeidats@myune.edu.au], Palaeoscience Research Centre, University of New England, Armidale, New South Wales 2351, Australia; Marissa J. Betts [mbetts7@une.edu.au], Palaeoscience Research Centre/LLUNE, University of New England, Armidale, New South Wales 2351, Australia; Maria Blake [maria.blake@monash.edu], School of Earth, Atmosphere and Environment, Monash University, 9 Rainforest Walk, Clayton, Victoria 3800, Australia; Phillip C. Boan [pboan001@ucr.edu], University of California, Riverside, Geology 1242, 900 University Ave, Riverside, CA 92521, U.S.A.; Tory Botha [tory.botha@adelaide.edu.au], School of Biological Sciences, Molecular Life Sciences Building, North Terrace Campus, The University of Adelaide, Adelaide, South Australia 5005, Australia; Glenn A. Brock [glenn.brock@mq.edu.au], School of Natural Sciences, Macquarie University, New South Wales 2109, Australia; Luke Brosnan [Luke.Brosnan@postgrad.curtin.edu.au], WA Organic and Isotope Geochemistry Centre, The Institute for Geoscience Research, School of Earth and Planetary Sciences, Building 500, Curtin University, Kent St, Bentley, Western Australia 6102, Australia; Jack Castle-Jones [jack.jones1@students.mq.edu.au], School of Natural Sciences, Macquarie University, New South Wales 2109, Australia; Jonathan Cramb [jonathan.cramb@qm.qld.gov.au], Queensland Museum, PO Box 3300, South Brisbane BC, Queensland 4101, Australia; Vanesa L. De Pietri [vanesa.depietri@canterbury.ac.nz], School of Earth and Environment, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand; Sherri Donaldson [sherri.donaldson.oz@gmail.com], School of Geosciences, University of Edinburgh, Grant Institute, The King’s Buildings, James Hutton Road, Edinburgh, EH9 3FE, Scotland, U.K.; Elizabeth M. Dowding [dowdingem@gmail.com], Friedrich-Alexander-Universität Erlangen-Nürnberg, Loewenichstraße 28 91054 Erlangen, Germany; Ruairidh Duncan [ruairidh.duncan@monash.edu], Evans EvoMorph Lab, Room 226, 18 Innovation Walk, School of Biological Sciences, Monash University, Clayton, Victoria 3800, Australia; Amy L. Elson [amy.elson@curtin.edu.au], WA Organic and Isotope Geochemistry Centre, The Institute for Geoscience Research, School of Earth and Planetary Sciences, Building 500, Curtin University, Kent St, Bentley, Western Australia 6102, Australia; Roy M. Farman [r.farman@unsw.edu.au], School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, New South Wales 2052, Australia; Mahala A. Fergusen [mahala.fergusen@adelaide.edu.au], School of Biological Sciences, Benham Building, North Terrace Campus, The University of Adelaide, Adelaide, South Australia 5005, Australia; Alyssa Fjeld [alyssa.fjeld@monash.edu], School of Biological Sciences, 18 Innovation Walk, Monash University, Clayton, Victoria 3800, and School of Natural Sciences, Macquarie University, New South Wales 2109, Australia; David Flannery [david.flannery@qut.edu.au], School of Earth and Atmospheric Sciences, Queensland University of Technology, 2 George St, Brisbane, Queensland 4000, Australia; Timothy G. Frauenfelder [timothy.frauenfelder@gmail.com], University of New England, Armidale, New South Wales 2351, Australia; John D. Gorter [johngorter1@gmail.com], PO Box 711, Claremont, Western Australia 6910, Australia; Michelle Gray [m.gray@research.deakin.edu.au], School of Life and Environmental Sciences, Deakin University, Geelong, Victoria 3216, Australia; Nigel Gray [nlg2225@gmail.com], GPO Box 2902, Brisbane, Queensland 4001, Australia; Peter Haines [peter.haines@dmirs.wa.gov.au], Geological Survey of Western Australia, Department of Energy, Mines, Industry Regulation and Safety, 100 Plain St, East Perth, Western Australia 6004, Australia; Lachlan J. Hart [lachlan.hart@australian.museum], Australian Museum Research Institute, 1 William Street, Sydney, New South Wales 2010, Australia; Brooke E. Holland [b.holland@uq.net.au], School of Biological Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia; James D. Holmes [jamesholmes83@gmail.com], Department of Earth Sciences, Palaeobiology, Uppsala University, Villavägen 16, Uppsala 752 36, Sweden; Lars Holmer [lars.holmer@pal.uu.se], Department of Earth Sciences, Palaeobiology, Uppsala University, Villavägen 16, Uppsala 752 36, Sweden; Ashleigh V.S. Hood [ashleigh.hood@unimelb.edu.au], School of Geography, Earth and Atmospheric Sciences, University of Melbourne, Parkville, Victoria 3010, Australia; Alexey P. Ippolitov [ippolitov.ap@gmail.com], School of Geography, Environment and Earth Sciences, Victoria University of Wellington | Te Herenga Waka, 21 Kelburn Parade, Wellington 6012, New Zealand; Christine M. Janis [christine_janis@brown.edu], Bristol Palaeobiology Group, School of Earth Sciences, University of Bristol, Wills Memorial Building, Bristol, BS8 1RJ, U.K.; Benjamin P. Kear [benjamin.kear@em.uu.se], The Museum of Evolution, Uppsala University, Norbyvägen 16, SE-752 36 Uppsala, Sweden; Sophie Kelly [sophie.kelly@pg.canterbury.ac.nz], School of Earth and Environment, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand; Justin L. Kitchener [jkitche3@myune.edu.au], School of Environmental and Rural Science, University of New England, Armidale, New South Wales 2351, Australia; John R. Laurie [john.r.laurie@gmail.com], Geoscience Australia, Symonston, Australian Capital Territory 2601, and School of Natural Sciences, Macquarie University, North Ryde, New South Wales 2109, Australia; Lucy G. Leahey [lucyleahey@hotmail.com], The University of Queensland, Brisbane, Queensland 4072, Australia; John A. Long [john.long@flinders.edu.au], College of Science and Engineering, Flinders University, PO Box 2100, Adelaide, South Australia 5001, Australia; Daniel Mantle [dan.mantle@mgpalaeo.com.au], MGPalaeo, Unit 1, 5 Arvida Street, Malaga, Western Australia 6090, Australia; David McB. Martin [david.martin@dmirs.wa.gov.au], Geological Survey of Western Australia, Department of Energy, Mines, Industry Regulation and Safety, 100 Plain St, East Perth, Western Australia 6004, Australia; Chris Mays [cmays@ucc.ie], School of Biological, Earth and Environmental Sciences, Environmental Research Institute, University College Cork, Distillery Fields, Cork T23 N73K, Ireland; Matthew R. McCurry [matthew.mccurry@austmus.gov.au], Australian Museum, 1 William St, Sydney, New South Wales 2010, Australia; Peter McGoldrick [p.mcgoldrick@utas.edu.au], CODES, University of Tasmania, Locked Bag 66, Hobart, Tasmania 7001, Australia; Corinne L. Mensforth [mens0009@flinders.edu.au], Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia; Rhys D. Meyerkort [meyerkortr@gmail.com], University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia 6009, Australia; Christina Nielsen-Smith [c.nielsensmith@uq.net.au], School of Biological Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia; Ryan Nel [ryan2nel@gmail.com], Geology Department, Rhodes University, Grahamstown, South Africa; Jake Newman-Martin [jake.newman-martin@student.curtin.edu.au], Curtin University, Kent St, Bentley, Western Australia 6102, Australia; Yeongju Oh [yjoh@kopri.re.kr], Division of Earth Sciences, Korea Polar Research Institute, 26 Songdomirae-ro, Yeonsu-gu, 21990 Incheon, Republic of Korea, and Polar Science, University of Science and Technology, Daejeon, 34113, Republic of Korea; John R. Paterson [jpater20@une.edu.au], Palaeoscience Research Centre, School of Environmental and Rural Science, University of New England, Armidale, New South Wales 2351, Australia; Jacob Pears [J.pears@imperial.ac.uk], School of Molecular and Life Sciences, Curtin University, Kent St, Bentley, Western Australia 6102, Australia; Stephen F. Poropat [steve.poropat@curtin.edu.au], Western Australian Organic and Isotope Geochemistry Centre, School of Earth and Planetary Science, Curtin University, Kent St, Bentley, Western Australia 6102, and Australian Age of Dinosaurs Museum of Natural History, Winton, Queensland 4735, Australia; Catherine M. Reid [catherine.reid@canterbury.ac.nz], School of Earth and Environment, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand; R. Pamela Reid [preid@rsmas.miami.edu], Department of Marine Geosciences, Rosenstiel School of Marine, Atmospheric, and Earth Science, University of Miami, Miami, FL 33149, U.S.A., and Bahamas Marine EcoCentre, Miami, FL 33158, U.S.A.; Stephanie A. Richter Stretton [srichte2@myune.edu.au], Palaeoscience Research Centre, School of Environmental and Rural Science, University of New England, Armidale, New South Wales 2351, Australia; Ben Robertson [ben.t.robertson@adelaide.edu.au], School of Physics, Chemistry and Earth Sciences, Mawson Building Room 107, University of Adelaide, North Terrace Campus, Adelaide, South Australia 5005, Australia; Helen E. Ryan [helen.ryan@museum.wa.gov.au], Department of Earth and Planetary Sciences, Western Australian Museum, 49 Kew Street, Welshpool, Western Australia 6106, Australia; Steven W. Salisbury [s.salisbury@uq.edu.au], School of Biological Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia; Donna Satterthwait [Donna.Satterthwait@utas.edu.au], CODES, University of Tasmania, Locked Bag 66, Hobart, Tasmania 7001, Australia; Natalie I. Schroeder [Natalie.Schroeder@ga.gov.au], Geoscience Australia, GPO Box 378, Canberra, Australian Capital Territory 2601, Australia; Yogmaya Shukla [yogmayashukla@bsip.res.in; yogmayashukla@gmail.com], Birbal Sahni Institute of Palaeosciences, Lucknow-226007, India; Miriam Slodownik [miriam.slodownik@adelaide.edu.au], School of Biological Sciences, University of Adelaide, North Terrace, South Australia 5005, Australia; Patrick M. Smith [Patrick.Smith@austmus.gov.au], Australian Museum, 1 William St, Sydney, New South Wales 2010, Australia, and Department of Biological Sciences, Macquarie University, Sydney, New South Wales 2109, Australia; Nile P. Stephenson [nps36@cam.ac.uk], Department of Zoology, Downing Pl, University of Cambridge, CB2 3EJ, U.K.; Rachel L. Surprenant [rsurp001@ucr.edu], University of California Riverside, 900 University Ave, Riverside, CA 92521, U.S.A.; Kailah M. Thorn [Kailah.thorn@museum.wa.gov.au], Department of Terrestrial Vertebrates, Western Australia Museum, 49 Kew Street, Welshpool, Western Australia 6101, Australia; Kenny J. Travouillon [kenny.travouillon@museum.wa.gov.au], Western Australian Museum, 49 Kew Street, Welshpool, Western Australia 6101, Australia; Kate M. Trinajstic [K.Trinajstic@curtin.edu.au], School of Molecular and Life Sciences, Curtin University, Kent Street, Bentley, Western Australia 6102, Australia; Madison Tripp [madison.tripp@postgrad.curtin.edu.au], Organic and Isotope Geochemistry Centre, School of Earth and Planetary Science, Curtin University, Kent St, Bentley, Western Australia 6102, Australia; Vikram Vakil [vikram.vakil@uqconnect.edu.au], School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia; Elizabeth A. Weldon [l.weldon@deakin.edu.au], School of Life and Environmental Sciences, Deakin University, Geelong, Victoria 3216, Australia; Joshua White [Joshua.white@anu.edu.au], Research School of Physics, Department of Materials Physics, Australian National University, Canberra, Australian Capital Territory 2601, and Australian Museum Research Institute, 1 William Street, Sydney, New South Wales 2010, Australia; Robbert J. Willink [robblink@ozemail.com.au], 11 Coral Sea Court, Sunshine Beach, Queensland 4567, Australia; Gemma L. Wise [g.wise@uq.net.au], School of Biological Sciences, The University of Queensland, Brisbane, Queensland 4072, Australia; Christina R. Woltz [cwoltz@stanford.edu], Department of Earth and Planetary Sciences, Stanford University, 450 Jane Stanford Way, Stanford, CA 94305-2115, U.S.A; George Young [george.young@pg.canterbury.ac.nz], School of Earth and Environment, University of Canterbury, Private Bag 4800, Christchurch, New Zealand; Zhiliang Zhang[zhiliang.zhang@nigpas.ac.cn], Nanjing Institute of Geology and Palaeontology, Chinese Academy of Sciences, Nanjing 210008, People’s Republic of China; Yong Yi Zhen [yong-yi.zhen@regional.nsw.gov.au], Geological Survey of New South Wales, 947–953 Londonderry Road, Londonderry, New South Wales 2753, Australia; Tim Ziegler [tziegler@museum.vic.gov.au], Museums Victoria Research Institute, GPO Box 666, Melbourne, Victoria 3001, Australia.

Older individuals are at an increased risk of delayed recovery following a traumatic injury. Measurement of muscularity and frailty at hospital admission may aid with prognostication and risk stratification.

To determine the uptake of the Alfred Health Post‐COVID service among people hospitalised with coronavirus disease 2019 (COVID‐19) or referred by general practitioners; to describe their characteristics and symptoms at eight weeks and the clinical services they required. Observational cohort study. Outpatient post‐COVID‐19 follow‐up service in a tertiary Melbourne hospital. All people admitted to Alfred Health (inpatients, hospital‐in‐the‐home) with COVID‐19, 19 March 2020 – 28 December 2022; people with persistent symptoms referred by general practitioners in the Alfred Health catchment area during 2022. Questionnaire‐based symptom assessment eight weeks after onset of COVID‐19. Dyspnoea, fatigue, depression, anxiety, and post‐traumatic stress disorder were assessed with standardised tools, as were health status and health‐related quality of life; return to work or study, weight loss, and altered cognition and memory were also assessed. Screening was followed by physical assessment and management at the service (specialist general medicine review, physiotherapist, allied health assistant, neuropsychologist) and referral to other specialist medical services as required. Proportion of eligible people who used the service for follow‐up at eight weeks; proportions of service users who reported symptoms and return to pre‐COVID‐19 employment or study; clinical services required by service users. Of 6712 people invited for screening, 726 completed questionnaires (11%). At least one persistent symptom was reported by 385 of 642 respondents (60% of respondents, 5.7% of invitees), most frequently memory (371 of 656, 57%) or concentration problems (431 of 656, 66%), dyspnoea (197 of 703, 28%), and extreme fatigue (189 of 673, 28%). Sixty‐seven of 453 respondents had not returned to pre‐COVID‐19 work or study (15%). People were referred to a variety of medical and non‐medical services for management, including specialist medical clinics, allied health, and rehabilitation. Among 71 people who also completed questionnaires at twelve months, the proportions who reported fatigue, anxiety, and memory and concentration changes were similar at both assessments. After acute COVID‐19 that required hospital admission or was followed by persistent symptoms in community care, a small proportion of people (5.7%) reported symptoms that required medical and allied health specialist assessment and management. Our findings may assist planning services for people with long COVID.

The burden of coronary artery disease (CAD) is large and growing, commonly presenting with comorbidities and older age. Patients may benefit from coronary revascularisation with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), yet half of patients with CAD who would benefit from revascularisation fall outside the eligibility criteria of trials to date. As such, the choice of revascularisation procedures varies depending on the CAD anatomy and complexity, surgical risk and comorbidities, the patient’s preferences and values, and the treating team’s expertise. The recent American guidelines on coronary revascularisation are comprehensive in describing recommendations for PCI, CABG, or conservative management in patients with CAD. However, individual challenging patient presentations cannot be fully captured in guidelines. The aim of this narrative review is to summarise common clinical scenarios that are not sufficiently described by contemporary clinical guidelines and trials in order to inform heart team members and trainees about the nuanced considerations and available evidence to manage such cases. We discuss clinical cases that fall beyond the current guidelines and summarise the relevant evidence evaluating coronary revascularisation for these patients. In addition, we highlight gaps in knowledge based on a lack of research (eg, ineligibility of certain patient populations), underrepresentation in research (eg, underenrollment of female and non-White patients), and the surge in newer minimally invasive and hybrid techniques. We argue that ultimately, evidence-based medicine, patient preference, shared decision making, and effective heart team communications are necessary to best manage complex CAD presentations potentially benefitting from revascularisation with CABG or PCI.

Out-of-hospital cardiac arrest is a leading cause of death, accounting for ≈50% of all cardiovascular deaths. The prognosis of such individuals is poor, with <10% surviving to hospital discharge. Survival with a favorable neurologic outcome is highest among individuals who present with a witnessed shockable rhythm, received bystander cardiopulmonary resuscitation, achieve return of spontaneous circulation within 15 minutes of arrest, and have evidence of ST-segment elevation on initial ECG after return of spontaneous circulation. The cardiac catheterization laboratory plays an important role in the coordinated Chain of Survival for patients with out-of-hospital cardiac arrest. The catheterization laboratory can be used to provide diagnostic, therapeutic, and resuscitative support after sudden cardiac arrest from many different cardiac causes, but it has a unique importance in the treatment of cardiac arrest resulting from underlying coronary artery disease. Over the past few years, numerous trials have clarified the role of the cardiac catheterization laboratory in the management of resuscitated patients or those with ongoing cardiac arrest. This scientific statement provides an update on the contemporary approach to managing resuscitated patients or those with ongoing cardiac arrest.

IntroductionPrevious systematic reviews have provided heterogeneous and differing estimates for the efficacy of pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease (COPD). The aim of this review was to examine the efficacy of pulmonary rehabilitation programmes initiated within 3 weeks of hospital discharge following an exacerbation of COPD.MethodsAn update of a previous Cochrane review was undertaken using the Cochrane Airways Review Group Specialised Register. Searches were conducted from October 2015 to August 2023 for studies that initiated pulmonary rehabilitation within 3 weeks of hospital discharge. Studies assessing the impact of solely inpatient pulmonary rehabilitation were excluded. Forest plots were generated using a generic inverse variance random effects method.ResultsSeventeen studies were included. Posthospital discharge pulmonary rehabilitation reduced hospital re-admissions (OR 0.48, 95% CI 0.30 to 0.77, I2=67%), improved exercise capacity (6 min walk test, mean difference (MD) 57 m, 95% CI 29 to 86, I2=89%; incremental shuttle walk test, MD 43 m, 95% CI 6 to 79, I2=81%), health-related quality of life (St. George’s Respiratory Questionnaire, MD −8.7 points, 95% CI −12.5 to −4.9, I2=59%; Chronic Respiratory Disease Questionnaire (CRQ)-emotion, MD 1.0 points, 95% CI 0.4 to 1.6, I2=74%; CRQ-fatigue, MD 0.9 points, 95% CI 0.1 to 1.6, I2=91%), and dyspnoea (CRQ-dyspnoea, MD 1.0 points, 95% CI 0.3 to 1.7, I2=87%; modified Medical Research Council Dyspnoea Scale, MD −0.3 points, 95% CI −0.5 to −0.1, I2=60%). Significant effects were not observed for CRQ-mastery, COPD assessment test, EuroQol-5 Dimension-5 Level and mortality. No intervention-related adverse events were reported.DiscussionPulmonary rehabilitation delivered posthospital discharge for exacerbation of COPD results in a reduction in hospital re-admissions and improvements in exercise capacity, health-related quality of life and dyspnoea in the absence of any intervention-related adverse events.Trial registration numberCRD42023406397.

A novel readout architecture that uses multiple nondestructive floating-gate amplifiers (FGAs) to achieve subelectron readout noise in a thick, fully depleted silicon detector is presented. This multiple-amplifier sensing charge-coupled device (MAS-CCD) can perform multiple independent charge measurements with each amplifier; measurements with multiple amplifiers can then be combined to further reduce the readout noise. This allows getting subelectron noise operation in less time compared with single-nondestructive-amplifier CCDs. The performance of this detector is demonstrated, emphasizing the ability to resolve individual quanta and to combine measurements across amplifiers to reduce readout noise. These characteristics make it a candidate technology for astronomical observations, quantum imaging, and low-energy interacting particles.

To develop, validate, and test the reproducibility of a new test capable of assessing functional performance in children and adolescents (PAY test: Performance Activity in Youth).

What are the effects of a brief intervention to promote physical activity (PA) delivered in a health care setting other than primary care? MEDLINE, EMBASE, CINAHL and PsycINFO were used to identify randomised controlled trials which evaluated the effect of brief interventions to increase PA, delivered in a health care setting. Review outcomes included subjectively or objectively measured PA, adherence to prescribed interventions, adverse events, health‐related quality of life, self‐efficacy and stage of change in relation to PA. Where possible, clinically homogenous studies were combined in a meta‐analysis. Twenty‐five eligible papers were included. Brief counselling interventions were associated with increased PA compared to control, for both self‐reported PA (mean difference 34 minutes/week, 95% confidence intervals [95% CI] 9‐60 minutes), and pedometer (MD 1541 steps/day, 95% CI 433‐2649) at medium term follow up. Our findings suggest that some brief interventions to increase PA, delivered in the health care setting, are effective at increasing PA in the medium term. There is limited evidence for the long‐term efficacy of such interventions. The wide variation in types of interventions makes it difficult to determine which intervention features optimize outcomes. Brief counselling interventions delivered in a health care setting may support improved PA. Clinicians working in health care settings should consider the implementation of brief interventions to increase PA in vulnerable patient groups, including older adults and those with chronic illness.

Characterize the prevalence of chronic physical illness types and mental illness and their comorbidity among adolescents and young adults (AYA) and assess the association of comorbidity on hospital utilization.This study features a population-level sample of 61 339 insurance-eligible AYA with an analytic sample of 49 089 AYA (aged 12–21) in Vermont’s 2018 all-payer database. We used multiple logistic regressions to examine the associations between physical illness types and comorbid mental illness and emergency department (ED) use and inpatient hospitalization.The analytic sample was 50% female, 63% Medicaid, and 43% had ≥1 chronic illness. Mental illness was common (31%) and highly comorbid with multiple physical illnesses. Among AYA with pulmonary illness, those with comorbid mental illness had 1.74-times greater odds (95% confidence interval [CI]: 1.49–2.05, P ≤.0005) of ED use and 2.9-times greater odds (95% CI: 2.05–4.00, P ≤.0005) of hospitalization than those without mental illness. Similarly, comorbid endocrine and mental illness had 1.84-times greater odds of ED use (95% CI: 1.39–2.44, P ≤.0005) and 2.1-times greater odds of hospitalization (95% CI: 1.28–3.46, P = .003), comorbid neurologic and mental illness had 1.36-times greater odds of ED use (95% CI: 1.18–1.56, P ≤.0005) and 2.4-times greater odds of hospitalization (95% CI: 1.73–3.29, P ≤.0005), and comorbid musculoskeletal and mental illness had 1.38-times greater odds of ED use (95% CI: 1.02–1.86, P = .04) and 2.1-times greater odds of hospitalization (95% CI: 1.20–3.52, P = .01).Comorbid physical and mental illness was common. Having a comorbid mental illness was associated with greater ED and inpatient hospital utilization across multiple physical illness types.

IMPORTANCE: Tumor necrosis factor α (TNF) inhibitor–induced psoriasiform eruption is well recognized in adults, but few reports document this paradoxical effect in children. OBJECTIVE: To characterize the clinical features and the clinical time course of TNF inhibitor–induced psoriasiform eruptions in children. DESIGN, SETTING, AND PARTICIPANTS: A multicenter retrospective case series of children younger than 18 years seen between January 1, 2000, and December 31, 2016, who developed a new-onset psoriasiform eruption while taking a TNF inhibitor for a nondermatologic disorder. Participating sites were members of the Pediatric Dermatology Research Alliance. Data were entered into a Research Electronic Data Capture database at the Mayo Clinic (ie, the coordinating center). RESULTS: Psoriasiform eruptions were identified in 103 TNF inhibitor–treated patients (median age, 13.8 years [IQR, 11.7-16.4 years]; 52 female patients [50%]; 57 White patients [55%]), with 67 patients (65%) treated with infliximab, 35 (34%) with adalimumab, and 1 (1%) with certolizumab pegol. Most patients had no personal history (101 [98%]) or family history of psoriasis (60 patients [58%]). Inflammatory bowel disease was the most common indication for treatment with TNF inhibitor (94 patients [91%]). The primary extracutaneous disease was under control in 95 patients (92%) who developed the eruption. Most patients (n = 85 [83%]) developed psoriasiform eruptions at multiple anatomic sites, with scalp involvement being most common (65 patients [63%]). Skin disease developed at a median of 14.5 months (IQR, 9-24 months) after TNF inhibitor initiation. To treat the psoriasiform eruption, topical steroidal and nonsteroidal medication was prescribed for all patients. Systemic therapy was added for 30 patients (29%): methotrexate for 24 patients (23%), oral corticosteroids for 8 patients (8%), and azathioprine for 1 patient (1%). For 26 patients (25%), suboptimal effectiveness with topical medications alone prompted discontinuation of the initial TNF inhibitor and a change to a second-line TNF inhibitor with cutaneous improvement in 23 patients (88%) by a median of 3 months (IQR, 2-4 months). Eight patients (31%) who started a second-line TNF inhibitor developed a subsequent TNF inhibitor–induced psoriasiform eruption at a median of 6 months (IQR, 4-8 months). Persistent skin disease in 18 patients (17%) prompted discontinuation of all TNF inhibitors; 11 patients changed to a non-TNF inhibitor systemic therapy, and 7 discontinued all systemic therapy. CONCLUSIONS AND RELEVANCE: In this case series, paradoxical TNF inhibitor–induced psoriasiform eruptions were seen in children treated with TNF inhibitors for any indication, and there appears to be a class effect among the varying TNF inhibitors. The majority of these children were able to continue TNF inhibitor therapy with adequate skin-directed and other adjuvant therapies.

Autonomy-supportive health environments can assist patients in achieving behavior change and can influence adherence positively. Telerehabilitation may increase access to rehabilitation services, but creating an autonomy-supportive environment may be challenging.

Objective People living with dementia often have high care needs at the end-of-life. We compared care delivery in the last year of life for people living with dementia in the community (home or assisted living facilities [ALFs]) versus those in skilled nursing facilities (SNFs).Methods A retrospective study was performed of older adults with a dementia diagnosis who died in the community or SNFs from 2013 through 2018. Primary outcomes were numbers of hospitalizations and emergency department visits in the last year of life. Secondary outcomes were completed advance care plans, hospice enrollment, time in hospice, practitioner visits, and intensive care unit admissions.Results Of 1203 older adults with dementia, 622 (51.7%) lived at home/ALFs; 581 (48.3%) lived in SNFs. At least 1 hospitalization was recorded for 70.7% living at home/ALFs versus 50.8% in SNFs (P< .001), similar to percentages of emergency department visits (80.2% vs 58.0% of the home/ALF and SNF groups, P< .001). SNF residents had more practitioner visits than home/ALF residents: median (IQR), 9.0 (6.0-12.0) versus 5.0 (3.0-9.0; P< .001). No advance care plan was documented for 12.2% (n = 76) of the home/ALF group versus 4.6% (n = 27) of the SNF group (P< .001). Nearly 57% of SNF residents were enrolled in hospice versus 68.3% at home/ALFs (P< .001). The median time in hospice was 26.5 days in SNFs versus 30.0 days at home/ALFs (P= .67).Conclusions Older adults with dementia frequently receive acute care in their last year of life. Hospice care was more common for home/ALF residents. Time in hospice was short.

BackgroundPhysical activity levels are known to decline following hospitalisation for people with cystic fibrosis (pwCF). However, optimal physical activity promotion strategies are unclear. This study investigated the effect of a web-based application (ActivOnline) in promoting physical activity in young pwCF.MethodsMulticentre randomised controlled trial with assessor blinding and qualitative evaluation. People with CF (12–35 years) admitted to hospital for a respiratory cause were eligible and randomised to the 12-week ActivOnline intervention (AO) or usual care (UC). The primary outcome was change in device-based time spent in moderate-to-vigorous physical activity (MVPA) from baseline to post-intervention. Follow-up was at 6 months from hospital discharge when qualitative evaluation was undertaken.Results107 participants were randomised to AO (n=52) or UC (n=55). Sixty-three participants (59%) contributed to the intention-to-treat analysis. Mean (SD) age was 21 (6) years (n=46, <18 years). At baseline, physical activity levels were high in both groups (AO 102 (52) vs UC 127 (73) min/day). There was no statistically significant difference in MVPA between groups at either timepoint (post-intervention mean difference (95% CI) −14 mins (−45 to 16)). Uptake of the intervention was low with only 40% (n=21) of participants accessing the web application.ConclusionA web-based application, including individualised goal setting, real-time feedback and motivation for behavioural change, was no better than usual care at promoting physical activity in young pwCF following hospital discharge. High levels of baseline physical activity levels in both groups, and limited engagement with the intervention, suggest alternative strategies may be necessary to identify and support young pwCF who would benefit from enhanced physical activity.Trial registration numberACTRN12617001009303, 13 July 13 2017.

Neutrons from an atmospheric nuclear explosion can be detected by sensors in orbit. Current tools for characterizing the neutron energy spectrum assume a known source and use forward transport to recreate the detector response. In realistic scenarios the true source is unknown, making this an inefficient, iterative approach. In contrast, the adjoint approach directly solves for the source spectrum, enabling source reconstruction. The time–energy fluence at the satellite and adjoint transport equation allow a Monte Carlo method to characterize the neutron source’s energy spectrum directly in a new model: the Space to High-Altitude Region Adjoint (SAHARA) model. A new adjoint source event estimator was developed in SAHARA to find feasible solutions to the neutron transport problem given the constraints of the adjoint environment. This work explores SAHARA’s development and performance for mono-energetic and continuous neutron energy sources. In general, the identified spectra were shifted towards energies approximately 5% lower than the true source spectra, but SAHARA was able to capture the correct spectral shapes. Continuous energy sources, including real-world sources Fat Man and Little Boy, resulted in identifiable spectra that could have been produced by the same distribution as the true sources as demonstrated by two-dimensional (2D) Kolmogorov–Smirnov tests.

The objective of this study was to conduct a scoping review to comprehensively map the breadth of literature related to the rehabilitation of adult patients whilst on extracorporeal membrane oxygenation (ECMO) and identify gaps and areas for future research.

We present characterization results and performance of a prototype Multiple-Amplifier Sensing (MAS) silicon charge-coupled device (CCD) sensor with 16 channels potentially suitable for faint object astronomical spectroscopy and low-signal, photon-limited imaging. The MAS CCD is designed to reach sub-electron readout noise by repeatedly measuring charge through a line of amplifiers during the serial transfer shifts. Using synchronized readout electronics based on the Dark Energy Spectroscopic Instrument CCD controller, we report a read noise of 1.03 e−rms pix−1at a speed of 26 μs pix−1with a single-sample readout scheme where charge in a pixel is measured only once for each output stage. At these operating parameters, we find the amplifier-to-amplifier charge transfer efficiency (ACTE) to be >0.9995 at low counts for all amplifiers but one for which the ACTE is 0.997. This charge transfer efficiency falls above 50,000 electrons for the read-noise optimized voltage configuration we chose for the serial clocks and gates. The amplifier linearity across a broad dynamic range from ∼300 to 35,000 e−was also measured to be ±2.5%. We describe key operating parameters to optimize on these characteristics and describe the specific applications for which the MAS CCD may be a suitable detector candidate.

Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.

BackgroundThe impact of pulmonary rehabilitation (PR) on survival in patients with fibrotic interstitial lung disease (ILD) is unknown. Given the challenges conducting a large randomised controlled trial, we aimed to determine whether improvement in 6-minute walk distance (6MWD) was associated with better survival.MethodsThis retrospective, international cohort study included patients with fibrotic ILD participating in either inpatient or outpatient PR at 12 sites in 5 countries. Multivariable models were used to estimate the association between change in 6MWD and time to death or lung transplantation accounting for clustering by centre and other confounders.Results701 participants (445 men and 256 women) with fibrotic ILD were included. The mean±SD ages of the 196 inpatients and 505 outpatients were 70±11 and 69±12 years, respectively. Baseline/changes in 6MWD were 262±128/55±83 m for inpatients and 358±125/34±65 m for outpatients. Improvement in 6MWD during PR was associated with lower hazard rates for death or lung transplant on adjusted analysis for both inpatient (HR per 10 m 0.94, 95% CI 0.91 to 0.97, p<0.001) and outpatient PR (HR 0.97, 95% CI 0.95 to 1.00, p=0.042). Participation in ≥80% of planned outpatient PR sessions was associated with a 33% lower risk of death (95% CI 0.49% to 0.92%).ConclusionsPatients with fibrotic ILD who improved physical performance during PR had better survival compared with those who did not improve performance. Confirmation of these hypothesis-generating findings in a randomised controlled trial would be required to definitely change clinical practice, and would further support efforts to improve availability of PR for patients with fibrotic ILD.