Search

ObjectivesPaediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs.DesignA multicentre, international, collaborative cohort study.Setting91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020.ParticipantsPatients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin’s lymphoma, Hodgkin lymphoma, Wilms’ tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer.Main outcome measureAll-cause mortality at 30 days and 90 days.Results1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (pConclusionsThe COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally.

Complaints that there are “fewer applicants” and/or “less qualified candidates” applying for positions as police/public safety officers may reflect a larger or growing problem in this field’s recruitment efforts today. The two surveys and six survey studies conducted here, including a one-year follow-up, were initiated in order to identify the perceptions of working police/public safety psychologists who regularly attend at least one of three national conferences and may provide a representative base of active police/public safety psychology professionals today. Results include the documented perceptions of these psychologists that up to 50% of their police/public safety agencies have lowered their officer selection standards in recent years, with 58% of the 2019 survey-responding psychologists (N = 51) reporting that at least one of their agencies “lowered its selection standards within the last 12 months.” Psychologists also reported a difference between their “current rate of candidate rejection” on pre-employment psychological evaluations (PEPEs) and their “desired rate of candidate rejection,” suggesting that police/public safety organizations may be hiring more “borderline” or potentially “psychologically-unfit” officers in recent years in order to fill officer vacancies. A number of reasons for apparently increasing selection challenges nationwide are documented in these psychologists’ completed surveys.

To evaluate temporal trends in the management of sinogenic intracranial suppuration and its outcomes in children.A systematic search of databases was performed (Medline, Embase, Cochrane, ClinicalTrials.gov).Studies in children (age18 years) with sinogenic subdural empyema, extradural abscess, and intraparenchymal abscess were included. Data on treatment strategies were extracted. Primary outcome was death90 days. Secondary outcomes were return to theater, neurologic disability at 6 months, and length of stay. Random effects meta-analysis and meta-regression were performed to investigate the effect of time and endoscopic sinus surgery (ESS) on these outcomes.A total of 32 retrospective observational studies involving 533 patients recruited across a 45-year period (1975-2020) were included. The pooled estimates for 90-day mortality, permanent neurologic disability, and return to theater were 2.3% (95% CI, 1.1%-3.6%;The outcomes of sinogenic intracranial complications have not changed over the last 45 years, and ESS was not associated with improved patient outcomes. Further high-quality studies are required to determine the most appropriate treatment modalities to improve the burden of morbidity associated with sinogenic intracranial suppuration in children.

Practicing nephrology in New York City, at the epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic in the United States, we have been struck by the continued focus on the concern that a critical deficiency of ventilators will occur. Our efforts in the past weeks have led us to fear

The COVID-19 pandemic created an unprecedented strain on hospitals in New York City. Although practitioners focused on the pulmonary devastation, resources for the provision of dialysis proved to be more constrained. To deal with these shortfalls, NYC Health and Hospitals/Bellevue, NYU Brooklyn, NYU Medical Center and the New York Harbor VA Healthcare System, put together a plan to offset the anticipated increased needs for kidney replacement therapy.Prior to the pandemic, peritoneal dialysis was not used for acute kidney injury at Bellevue Hospital. We were able to rapidly establish an acute peritoneal dialysis program at Bellevue Hospital for acute kidney injury patients in the intensive care unit. A dedicated surgery team was assembled to work with the nephrologists for bedside placement of the peritoneal dialysis catheters. A multi-disciplinary team was trained by the lead nephrologist to deliver peritoneal dialysis in the intensive care unit. Between April 8, 2020 and May 8, 2020, 39 peritoneal dialysis catheters were placed at Bellevue Hospital. 38 patients were successfully started on peritoneal dialysis. As of June 10, 2020, 16 patients recovered renal function. One end stage kidney disease patient was converted to peritoneal dialysis and was discharged. One catheter was poorly functioning, and the patient was changed to hemodialysis before recovering renal function. There were no episodes of peritonitis and nine incidents of minor leaking, which resolved. Some patients received successful peritoneal dialysis while being ventilated in the prone position.In summary, despite severe shortages of staff, supplies and dialysis machines during the COVID-19 pandemic, we were able to rapidly implement a de novo peritoneal dialysis program which enabled provision of adequate kidney replacement therapy to all admitted patients who needed it. Our experience is a model for the use of acute peritoneal dialysis in crisis situations.

cellF is the world’s first neuron-driven synthesiser. It is a collaborative project at the cutting-edge of experimental art and music that brings together artists, musicians, designers and scientists to create a cybernetic self-portrait. cellF is an autonomous, bio-analogue electronic musical instrument designed to operate independently and interact with human musicians. The instrument is controlled by a bio-engineered neural network or ‘brain’ derived from skin cells using induced pluripotent stem cell (iPSC) technology that is housed in a custom-built synthesiser ‘body’. This paper introduces the cellF project highlighting the background, bio-technology, embodiment, design and performance capabilities.

Introduction: Although many methods have been proposed to assess clinical performance during resuscitation, robust and generalizable metrics are still lacking. Further research is necessary to develop validated clinical performance assessment tools and show an improvement in outcomes after training. We aimed to establish evidence for validity of a previously published scoring instrumentVthe Clinical Performance Tool (CPT)Vdesigned to evaluate clinical performance during simulated pediatric resuscitations. Methods: This was a prospective experimental trial performed in the simulation laboratory of a pediatric tertiary care facility, with a pretest/posttest design that assessed residents before and after pediatric advanced life support (PALS) certification. Thirteen postgraduate year 1 (PGY1) and 11 PGY3 pediatric residents completed 5 simulated pediatric resuscitation scenarios each during 2 consecutive sessions; between the 2 sessions, they completed a full PALS certification course. All sessions were video recorded. Sessions werescoredbyraters usingtheCPT;totalscoreswereexpressed as a percentage of maximum points possible for each scenario. Validity evidence was established and interpreted according to Messick’s framework. Evidence regarding relations to other variables was assessed by calculating differences in scores between pre-PALS and post-PALS certification and PGY1 and PGY3 using a repeated-measures analysis of variance test. Internal structure evidence was established by assessing interrater reliability using intraclass correlation coefficients (ICCs) for each scenario, a G-study, and a variance component analysis of individual measurement facets (scenarios, raters, and occasions) and associated interactions. Results: Overall scores for the entire study cohort improved by 10% after PALS training. Scores improved by 9.9% (95% confidence interval [CI], 4.5Y15.4) for the pulseless nonshockable arrest (ICC, 0.85; 95% CI, 0.74Y0.92), 14.6% (95% CI, 6.7Y22.4) for the pulseless shockable arrest (ICC, 0.98; 95% CI, 0.96Y0.99), 4.1% (95% CI, j4.5 to 12.8) for the dysrhythmias (ICC, 0.92; 95% CI, 0.87Y0.96), 18.4% (95% CI, 9.7Y27.1) for the respiratory scenario (ICC, 0.97; 95% CI, 0.95Y0.98), and 5.3% (95% CI, j1.4 to 2.0) for the shock scenarios (ICC, 0.94; 95% CI, 0.90Y0.97). There were no differences between PGY1 and PGY3 scores before or after the PALS course. Reliability of the instrument was acceptable as demonstrated by a mean ICC of 0.95 (95% CI, 0.94Y0.96). The G-study coefficient was 0.94. Most variance could be attributed to the subject (57%). Interactions between subject and scenario and subject and occasion were 9.9% and 1.4%, respectively, and variance attributable to rater was minimal (0%). Conclusions: Pediatric residents improved scores on CPT after completion of a PALS course. Clinical Performance Tool scores are sensitive to the increase in skills and knowledge resulting from such a course but not to learners’ levels. Validity evidence from scores for the CPT confirms implementation in new contexts and partially supports internal structure. More evidence is required to further support internal structure and especially to support relations with other variables and consequence evidence. Additional modifications should be made to the CPT before considering its use for high-stakes certification such as PALS. (Sim Healthcare 9:360Y369, 2014)

With the focus in healthcare around improving quality while reducing costs the clinical and economic management around the use of medications in the inpatient and outpatient settings is critical. In September 2014, drug expenditures increased 12.2 % overall, 13.3 % in clinics, and 4.0 % inpatient. Projections for 2015 are expected to increase by 9 %. Therefore, a variety of drug utilization strategies should be implemented across the healthcare sector including more deployment of pharmacists into direct patient care roles, clinical decision support, and electronic order sets. Meanwhile, specialty medications, used to treat diseases, such as rheumatoid arthritis, cystic fibrosis, Crohn’s disease, and cancer, have quickly been infused into the market resulting in strong patient outcomes but high expense and fragmentation of care. Retail and mail-order pharmacy services remain unchanged but home infusion is growing due to lower associated total cost of care. Managed care and government programs continue to evolve with healthcare cost constraints utilizing formulary management, restricted networks, rebate agreements with manufacturers, and prior authorization methodologies.

ME-5343 (afidopyropen) is a new and promising insecticide with an unknown mechanism of action that is effective against sucking insects. ME-5343 was highly toxic to pea aphids (Acyrthosiphon pisum), being more toxic than six other widely used insecticides. In contrast, ME-5343 was practically non-toxic to eight other species of insects we tested. ME-5343 was not toxic to German cockroaches (topical application) or American cockroaches (injection), suggesting that lack of toxicity in these species is not due to lack of cuticular penetration. House flies are insensitive to ME-5343 by topical, residual and feeding exposure. Addition of synergists did not change this result, suggesting that insensitivity to ME-5343 in house flies is not due to rapid detoxification nor is it dependent on the method of bioassay used. ME-5343 did not cause firefly lanterns to glow, nor did it prevent the octopamine stimulated lantern glow. Extracellular recordings of action potentials from a tonically active motor nerve of crayfish in situ showed no effects of ME-5343 at concentrations up to 10−5 M. These results suggest that the target site of ME-5343 is not the voltage gated sodium channel, voltage gated potassium channel, GABA gated chloride channel, nicotinic acetylcholine receptor, acetylcholinesterase, octopamine receptor or glutamate receptor. ME-5343 injected into crayfish caused flextion of the legs and tail, similar to the symptoms induced by 5-HT (serotonin). We evaluated the effect of ME-5343 on 5-HT2-like receptors with intracellular recordings of excitatory post-synaptic potentials from the peripheral neuromuscular junction of the crayfish and found no effect of ME-5343. Thus, ME-5343 was neither an agonist nor antagonist of 5-HT2 receptors, did not affect neurotransmitter release and did not affect glutamate receptors. We conclude that ME-5343 is highly toxic to aphids and that this is due to a unique, and currently undefined mechanism of action.

In recent years, there has been an increasing emphasis in health systems on the provision of ambulatory care services. Payers have created incentives to decrease hospitalization rates and length of stay, making way for a new shift toward pay-for-performance, outcomes-based reimbursement, and

This interview was conducted on January 4, 2006, with Nathan Thompson, director of outpatient pharmacy for the Johns Hopkins Home Care Group in Baltimore, Maryland. Below, Thompson describes some of the challenges Hopkins faced when developing an education plan about Medicare Part D for patients and