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ObjectiveThe objective of this study was to examine the impact of the introduction of the Universal Anaesthesia Machine (UAM), a device designed for use in clinical environments with limited clinical perioperative resources, on the choice of general anesthesia technique and safe anesthesia practice in a tertiary-care hospital in Sierra Leone.MethodsWe introduced an anesthesia machine (UAM) into Connaught Hospital, Freetown, Sierra Leone. We conducted a prospective observational study of anesthesia practice and an examination of perioperative clinical parameters among surgical patients at the hospital to determine the usability of the device, its impact on anesthesia capacity, and changes in general anesthesia technique.FindingsWe observed a shift from the use of ketamine total intravenous anesthesia to inhalational anesthesia. This shift was most demonstrable in anesthesia care for appendectomies and surgical wound management. In 10 of 17 power outages that occurred during inhalational general anesthesia, anesthesia delivery was uninterrupted because inhalational anesthesia was being delivered with the UAM.ConclusionAnesthesia technologies tailored to overcome austere environmental conditions can support the delivery of safe anesthesia care while maintaining fidelity to recommended international anesthesia practice standards.

ABSTRACT Objective: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. Methods: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. Results: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. Conclusion: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.

The aim of this study was to examine the safety and efficacy of 40 µm and 75 µm calibrated irinotecan-eluting beads (DEBIRI-TACE) for the treatment of colorectal cancer metastases. We conducted a retrospective review of 36 patients with unresectable liver metastases from colorectal cancer who were treated with DEBIRI-TACE between 2017 to 2020. Patients who received at least one session of DEBIRI were included in our analysis. A total of 105 DEBIRI sessions were completed. 86% of patients (n = 31) underwent one round of treatment, 14% of patients (n = 5) underwent two distinct rounds of treatment. The majority of patients were discharged the next day (92%, n = 33 patients) with no 30-day post-DEBIRI mortality. Five high-grade adverse events occurred, including longer stay for pain management (n = 2), postembolization syndrome requiring readmission (n = 2), and liver abscess (n = 1). The average survival from diagnosis of metastatic disease was 33.3 months (range 11–95, median 28). Nine of 36 patients are still alive (December 2020) and have an average follow-up time of 36.8 months from T0 (range 12–63, median 39). Small particle DEBIRI is safe and well-tolerated in the salvage setting, with outcomes comparable to that of larger bead sizes.

Resumo Objetivo Descrever o surto de varicela entre imigrantes venezuelanos em abrigos e ocupações nos municípios de Pacaraima e Boa Vista, Roraima, Brasil, e as medidas de controle implementadas. Métodos Estudo descritivo do tipo ‘série de casos’, realizado entre 21 de novembro e 13 de dezembro de 2019, sobre banco de dados secundários da investigação do surto disponibilizado pela Coordenação-Geral do Programa Nacional de Imunizações. Na análise descritiva, utilizaram-se medidas de frequência simples e relativa e foram calculadas medidas de tendência central e dispersão. Resultados Dos 9.591 imigrantes, detectaram-se 38 casos ativos e 1.459 suscetíveis à varicela. Dos casos ativos, 23 eram do sexo feminino e a faixa etária mais acometida foi a de menores de 9 anos (17 casos). Conclusão Identificaram-se pessoas suscetíveis a varicela na investigação; foram adotadas ações de imunização que controlaram a transmissão, evitando casos graves, óbitos e sobrecarga da rede de assistência à saúde local.

Abstract Background Sarcoidosis is a heterogeneous granulomatous disease with no accurate biomarkers of disease progression. Therefore, we profiled and integrated the DNA methylome, mRNAs, and microRNAs to identify molecular changes associated with sarcoidosis and disease progression that might illuminate underlying mechanisms of disease and potential biomarkers. Methods Bronchoalveolar lavage cells from 64 sarcoidosis subjects and 16 healthy controls were used. DNA methylation was profiled on Illumina HumanMethylationEPIC arrays, mRNA by RNA-sequencing, and miRNAs by small RNA-sequencing. Linear models were fit to test for effect of sarcoidosis diagnosis and progression phenotype, adjusting for age, sex, smoking, and principal components of the data. We built a supervised multi-omics model using a subset of features from each dataset. Results We identified 1,459 CpGs, 64 mRNAs, and five miRNAs associated with sarcoidosis versus controls and four mRNAs associated with disease progression. Our integrated model emphasized the prominence of the PI3K/AKT1 pathway, which is important in T cell and mTOR function. Novel immune related genes and miRNAs including LYST, RGS14, SLFN12L, and hsa-miR-199b-5p, distinguished sarcoidosis from controls. Our integrated model also demonstrated differential expression/methylation of IL20RB, ABCC11, SFSWAP, AGBL4, miR-146a-3p, and miR-378b between non-progressive and progressive sarcoidosis. Conclusions Leveraging the DNA methylome, transcriptome, and miRNA-sequencing in sarcoidosis BAL cells, we detected widespread molecular changes associated with disease, many which are involved in immune response. These molecules may serve as diagnostic/prognostic biomarkers and/or drug targets, although future testing is required for confirmation.

Objectives We aimed to assess the healthcare costs and impact on the economy at large arising from emergency medical services (EMS) treated non-traumatic shock.Design We conducted a population-based cohort study, where EMS-treated patients were individually linked to hospital-wide and state-wide administrative datasets. Direct healthcare costs (Australian dollars, AUD) were estimated for each element of care using a casemix funding method. The impact on productivity was assessed using a Markov state-transition model with a 3-year horizon.Setting Patients older than 18 years of age with shock not related to trauma who received care by EMS (1 January 2015–30 June 2019) in Victoria, Australia were included in the analysis.Primary and secondary outcome measures The primary outcome assessed was the total healthcare expenditure. Secondary outcomes included healthcare expenditure stratified by shock aetiology, years of life lived (YLL), productivity-adjusted life-years (PALYs) and productivity losses.Results A total of 21 334 patients (mean age 65.9 (±19.1) years, and 9641 (45.2%) females were treated by EMS with non-traumatic shock with an average healthcare-related cost of $A11 031 per episode of care and total cost of $A280 million. Annual costs remained stable throughout the study period, but average costs per episode of care increased (Ptrend=0.05). Among patients who survived to hospital, the average cost per episode of care was stratified by aetiology with cardiogenic shock costing $A24 382, $A21 254 for septic shock, $A19 915 for hypovolaemic shock and $A28 057 for obstructive shock. Modelling demonstrated that over a 3-year horizon the cohort lost 24 355 YLLs and 5059 PALYs. Lost human capital due to premature mortality led to productivity-related losses of $A374 million. When extrapolated to the entire Australian population, productivity losses approached $A1.5 billion ($A326 million annually).Conclusion The direct healthcare costs and indirect loss of productivity among patients with non-traumatic shock are high. Targeted public health measures that seek to reduce the incidence of shock and improve systems of care are needed to reduce the financial burden of this syndrome.

Konigsberg et al. profile DNA methylation in blood samples from SARS-CoV-2 cases and controls. The authors use machine learning to classify infected vs. non-infected individuals and predict clinical outcomes related to disease severity.

Plants are often confronted by different groups of herbivores, which threaten their growth and reproduction. However, they are capable of mounting defenses against would-be attackers which may be heightened upon attack. Resistance to insects often varies among plant species, with different genotypes exhibiting unique patterns of chemical and physical defenses. Within this framework, plant access to nutrients may be critical for maximal functioning of resistance mechanisms and are likely to differ among plant genotypes. In this study, we aimed to test the hypothesis that access to nutrition would alter the expression of plant resistance to insects and alter insect performance in a manner consistent with fertilization regime. We used two maize (Zea mays) genotypes possessing different levels of resistance and the fall armyworm (Spodoptera frugiperda) as model systems. Plants were subjected to three fertilization regimes prior to assessing insect-mediated responses. Upon reaching V4 stage, maize plants were separated into two groups, one of which was infested with fall armyworm larvae to induce plant defenses. Plant tissue was collected and used in insect bioassays and to measure the expression of defense-related genes and proteins. Insect performance differed between the two plant genotypes substantially. For each genotype, fertilization altered larval performance, where lower fertilization rates hindered larval growth. Induction of plant defenses by prior herbivory substantially reduced naïve fall armyworm growth in both genotypes. The effects between fertilization and induced defenses were complex, with low fertilization reducing induced defenses in the resistant maize. Gene and protein expression patterns differed between the genotypes, with herbivory often increasing expression, but differing between fertilization levels. The soluble protein concentrations did not change across fertilization levels but was higher in the susceptible maize genotype. These results demonstrate the malleability of plant defenses and the cascading effects of plant nutrition on insect herbivory.

BackgroundSudden cardiac death (SCD) is a major global health problem, accounting for up to 20% of deaths in Western societies. Clinical quality registries have been shown in a range of disease conditions to improve clinical management, reduce variation in care and improve outcomes.AimTo identify existing cardiac arrest (CA) and SCD registries, characterising global coverage and methods of data capture and validation.MethodsBiomedical and public search engines were searched with the terms ‘registry cardio*’; ‘sudden cardiac death registry’ and ‘cardiac arrest registry’. Registries were categorised as either CA, SCD registries or ‘other’ according to prespecified criteria. SCD registry coordinators were contacted for contemporaneous data regarding registry details.ResultsOur search strategy identified 49 CA registries, 15 SCD registries and 9 other registries (ie, epistries). Population coverage of contemporary CA and SCD registries is highly variable with registries densely concentrated in North America and Western Europe. Existing SCD registries (n=15) cover a variety of age ranges and subpopulations, with some enrolling surviving patients (n=8) and family members (n=5). Genetic data are collected by nine registries, with the majority of these (n=7) offering indefinite storage in a biorepository.ConclusionsMany CA registries exist globally, although with inequitable population coverage. Comprehensive multisource surveillance SCD registries are fewer in number and more challenging to design and maintain. Challenges identified include maximising case identification and case verification.Trial registration numberCRD42019118910.

Date Presented 03/26/20 As the need for education of caregivers for people with dementia increases, OT is well suited to fill the demand using an understanding of the whole person, need for meaningful occupation, and interaction with the environment. At this time, the contribution of OT is not well understood or sought after by families, physicians, and other practitioners. With evidence gained from validated research, the role of OT in dementia care is strengthened. Primary Author and Speaker: Lisa Hong Contributing Authors: Dana Howell, Elizabeth David Bowman, Jared Ricks, Theodore Peterson [ABSTRACT FROM AUTHOR]

The timing of events in the life history of temperate insects is most typically primarily cued by one of two drivers: photoperiod or temperature accumulation over the growing season. However, an insect's phenology can also be moderated by other drivers like rainfall or the phenology of its host plants. When multiple drivers of phenology interact, there is greater potential for phenological asynchronies to arise between an organism and those with which it interacts. We examined the phenological patterns of a highly seasonal group of fireflies (Photinus spp., predominantly P. pyralis) over a 12-year period (2004–2015) across 10 plant communities to determine whether interacting drivers could explain the variability observed in the adult flight activity density (i.e. mating season) of this species. We found that temperature accumulation was the primary driver of phenology, with activity peaks usually occurring at a temperature accumulation of approximately 800 degree days (base 10°C); however, our model found this peak varied by nearly 180 degree-day units among years. This variation could be explained by a quadratic relationship with the accumulation of precipitation in the growing season; in years with either high or low precipitation extremes at our study site, flight activity was delayed. More fireflies were captured in general in herbaceous plant communities with minimal soil disturbance (alfalfa and no-till field crop rotations), but only weak interactions occurred between within-season responses to climatic variables and plant community. The interaction we observed between temperature and precipitation accumulation suggests that, although climate warming has the potential to disrupt phenology of many organisms, changes to regional precipitation patterns can magnify these disruptions.

Advances in the field of nanobiotechnology are largely due to discoveries in the field of materials. Recent developments in the field of electrochemical biosensors based on transition metal nanomaterials as transducer elements have been beneficial as they possess various functionalities that increase surface area and provide well-defined active sites to accommodate elements for rapid detection of biomolecules. In recent years, transition metal dichalcogenides (TMDs) have become the focus of interest in various applications due to their considerable physical, chemical, electronic, and optical properties. It is worth noting that their unique properties can be modulated by defect engineering and morphology control. The resulting multifunctional TMD surfaces have been explored as potential capture probes for the rapid and selective detection of biomolecules. In this review, our primary focus is to delve into the synthesis, properties, design, and development of electrochemical biosensors that are based on transition metal dichalcogenides (TMDs) for the detection of biomolecules. We aim to explore the potential of TMD-based electrochemical biosensors, identify the challenges that need to be overcome, and highlight the opportunities for further future development.

The global crisis prevailing in the wake of the spread of COVID-19 has raised several speculations about the impact of the lockdown on the mental health of people. The dataset presented here is the assessment of the psychological distress experienced by people in India following the implementation of lockdown as a measure to curtail the spread of the coronavirus. The data was collected through a survey conducted by employing an online questionnaire assessing the socio-demographic information (9-items) as well as the administration of the short version of the General Health Questionnaire (GHQ-12 items) originally developed by Goldberg (1972). The period of data collection is between 9th April 2020 and 20th April 2020 where a total of 1,894 responses were obtained. The Google forms containing the questionnaire of the study were shared publicly through emails and via the social media forum like WhatsApp and Facebook. Thereby, those who took the initiative to fill-up the responses were included as the survey participants. Thus, the final sample had participants representing 17 states and Union territories of India. The entire dataset is stored in a Microsoft Excel Worksheet (.xls) and the questionnaire is attached as a supplementary file. The data is beneficial for the timely assessment of the nature and degree of the psychological distress experienced by people in India during the COVID-19 crisis. It could further be an assistance to the Government, policymakers as well as health care workers to take the adequate measures to ensure sound mental health among people.

Main Results: An outbreak of illness compatible with scurvy occurred among male prison inmates; most frequent signs/symptoms were edema and pain in lower limbs, difficulty in walking and hematoma/ecchymosis; the associated factor was age > 40 years., Implications for Services: The results can contribute to the identification and description of scurvy outbreaks in other contexts and territories. Epidemiological studies of events like this enhance the practice of field epidemiology in health services., Perspectives: It is expected that the prevention of hypovitaminosis, such as scurvy, will be based on public policies aimed at the population deprived of liberty; and that the capabilities of health services to detect and respond to cases of the disease will be improved., Objective: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020., Methods: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis., Results: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison., Conclusion: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.

Objective: To describe chickenpox outbreak among Venezuelan immigrants in shelters and occupancies in the municipalities of Pacaraima and Boa Vista, the state capital of Roraima, Brazil, and the control measures implemented., Methods: This was a descriptive case series study, conducted between November 21 and December 13, 2019, based on secondary database obtained from the outbreak investigation made available by the General Coordination for the National Immunization Program. Descriptive analysis was performed using simple and relative frequency measurements, and measures of central tendency and dispersion were calculated., Results: Of the 9,591 immigrants, 38 active cases and 1,459 susceptible to varicella were identified. With regard to active cases, 23 were female, and those aged under 9 years (17 cases) were the most affected., Conclusion: People susceptible to chickenpox were identified during the investigation. Immunization actions aimed at reducing transmission were adopted, thus preventing severe cases, deaths and overload in local health care system.

Objectives: To characterize the study population, estimating the in-hospital lethality rate by state and analysing associated factors with COVID-19-related deaths., Methods: A retrospective cohort study was carried out of hospitalised children and adolescents diagnosed with COVID-19, confirmed by RT-PCR, whose outcome was death by COVID-19 or recovery, from 2020 March 1 to August 1. The data source was the Influenza Epidemiological Surveillance Information System (SIVEP-Gripe in Brazilian acronym), where patients with Severe Acute Respiratory Syndrome (SARS) are notified. Children were defined as those between the ages of 0 and 11, and adolescents those between 12 and 18. A bi and multivariate analysis were performed using Poisson Regression with robust variance, with adjusted Relative Risk as the final association measure., Results: A total of 4,930 cases were analysed; 2,553 (51.8%) were males, 2,335 (47.4%) were brown-skinned. The Federative Unit of Roraima presented the highest in-hospital case-fatality rate, with 68.8% (11/16). Multivariate analysis showed that belonging to the age group adolescent (RR = 1.59; 95%CI 1.12 - 2.25; p = 0.009), SARS-critical patient (RR = 4.56; 95%CI 2, 77 - 7.51; p < 0.001) and presenting immunological disorders (RR = 2.24; 95%CI 1.58 - 3.17; p < 0.001) as comorbidities were statistically associated factors with death by COVID-19., Conclusion: It was observed that adolescents, SARS-critical patients, and presence of immunological disorders were important factors associated with death. Active surveillance and differentiated care are recommended for patients with chronic diseases and special immunological conditions.