Search

Abstract Background and aims Uncertainty persists over the effects of blood pressure (BP) lowering in acute stroke. The INTEnsive ambulance-delivered blood pressure Reduction in hyper-Acute stroke Trial (INTERACT4) aims to determine efficacy and safety of hyperacute intensive BP lowering in patients with suspected acute stroke. Given concerns over the safety of this treatment in the pre-hospital setting, particularly in relation to patients with intracerebral hemorrhage, we provide an update on progress of the study and profile of participants to date. Methods INTERACT4 is an ongoing multicentre, ambulance-delivered, randomized, open-label, blinded endpoint trial of pre-hospital BP lowering in patients with suspected acute stroke and elevated BP in China. Patients are randomized via a mobile phone digital system to intensive (target systolic BP [SBP]

Abstract Endothelial progenitor cells (EPCs), expressing markers for stemness (CD34), immaturity (CD133) and endothelial maturity (KDR), may determine the extent of post-stroke vascular repair. Given the prevalence of stroke in elderly, this study explored whether variations in plasmatic availability of certain EPC subtypes could predict the severity and outcome of disease in older patients. Blood samples were collected from eighty-one consented patients (≥ 65 years) at admission and days 7, 30 and 90 post-stroke. EPCs were counted with flow cytometry. Stroke severity and outcome were assessed using the National Institutes of Health Stroke Scale, Barthel Index and modified Rankin Scale. The levels of key elements known to affect EPC characteristics were measured by ELISA. Diminished total antioxidant capacity and CD34 + KDR + and CD133 + KDR + counts in early phases of stroke were associated with disease severity and worse functional outcome at day 90 post-stroke. Baseline levels of angiogenic agent PDGF-BB, but not VEGF, positively correlated with CD34 + KDR + numbers at day 90. Baseline LDL-cholesterol levels were inversely correlated with CD34 + KDR+, CD133 + KDR + and CD34 + CD133 + KDR + numbers at day 90. Close correlation between baseline CD34 + KDR + and CD133 + KDR + counts and the outcome of stroke proposes these particular EPC subtypes as potential prognostic markers for ischaemic stroke.

The interaction of myeloid-derived suppressor cells (MDSCs) with T cells within G-CSF-mobilized peripheral blood stem cell (PBSC) grafts in patients undergoing autologous or allogeneic hematopoietic stem cell transplantation remains to be elucidated. Through studying allo- and auto-PBSC grafts, we observed grafts containing large numbers of T cells and MDSCs with intergraft variability in their percentage and number. T cells from autologous grafts compared to allografts expressed relative higher percentages of inhibitory receptors PD-1, CTLA-4, TIM-3, LAG-3, TIGIT and BTLA. Autograft T cells had decreased cell proliferation and IFN-γ secretion, which supported the possible presence of T cell exhaustion. On the contrary, graft monocytic MDSCs (M-MDSCs) expressed multiple inhibitory receptor ligands, including PD-L1, CD86, Galectin-9, HVEM and CD155. The expression of inhibitory receptor ligands on M-MDSCs was correlated with their corresponding inhibitory receptors on T cells in the grafts. Isolated M-MDSCs had the ability to suppress T cell proliferation and IFN-γ secretion and/or promote Treg expansion. Blocking the PD-L1-PD-1 signaling pathway partially reversed the functions of M-MDSCs. Taken together, our data indicated that T cells and M-MDSCs in PBSC grafts express complementary inhibitory receptor–ligand pairing, which may impact the quality of immune recovery and clinical outcome post transplantation.

ObjectivesNational data on the health of children and adolescents exposed to commercial sexual exploitation (CSE) are lacking, during both adolescence and adulthood. Using nationally representative data, we examined the health of male and female adolescents in grades 7-12 who experienced CSE exposure and subsequent adult health outcomes and access to health care.MethodsOur retrospective cohort study used data from Waves I-IV of the National Longitudinal Study of Adolescent to Adult Health (1994-2008) to characterize relationships between CSE exposure before or during adolescence and health during adolescence and adulthood. The analytic sample included 10 918 adult participants aged 24-34 in Wave IV. We performed bivariate analyses, stratified by sex, to quantify the relationship between CSE exposure before or during adolescence and adolescent and adult health outcomes.ResultsFour percent of participants reported having a CSE exposure before or during adolescence (5% of males, 3% of females). Factors associated with CSE exposure among adolescents included race/ethnicity, parental education level, previous abuse, same-sex romantic attractions, history of ever having run away from home, and substance use. During adolescence, exposure to CSE was associated with worse overall health, depressive symptoms, and suicidal thoughts for both males and females. In adulthood, adolescent CSE exposure was associated with depression among males and functional limitations among females. A higher percentage of males with CSE exposure before or during adolescence, compared with their non-CSE-exposed peers, used the emergency department as their usual source of care during adulthood.ConclusionsCSE exposure before or during adolescence was associated with poor adolescent and adult health outcomes and health care access. Observed differences between males and females warrant further exploration.

Background Risk of recurrence after minor ischemic stroke is usually reported with transient ischemic attack. No previous meta‐analysis has focused on minor ischemic stroke alone. The objective was to evaluate the pooled proportion of 90‐day stroke recurrence for minor ischemic stroke, defined as a National Institutes of Health Stroke Scale severity score of ≤5. Methods and Results Published papers found on PubMed from 2000 to January 12, 2021, reference lists of relevant articles, and experts in the field were involved in identifying relevant studies. Randomized controlled trials and observational studies describing minor stroke cohort with reported 90‐day stroke recurrence were selected by 2 independent reviewers. Altogether 14 of 432 (3.2%) studies met inclusion criteria. Multilevel random‐effects meta‐analysis was performed. A total of 6 randomized controlled trials and 8 observational studies totaling 45 462 patients were included. The pooled 90‐day stroke recurrence was 8.6% (95% CI, 6.5–10.7), reducing by 0.60% (95% CI, 0.09–1.1; P=0.02) with each subsequent year of publication. Recurrence was lowest in dual antiplatelet trial arms (6.3%, 95% CI, 4.5–8.0) when compared with non‐dual antiplatelet trial arms (7.2%, 95% CI, 4.7–9.6) and observational studies 10.6% (95% CI, 7.0–14.2). Age, hypertension, diabetes, ischemic heart disease, or known atrial fibrillation had no significant association with outcome. Defining minor stroke with a lower National Institutes of Health Stroke Scale threshold made no difference – score ≤3: 8.6% (95% CI, 6.0–11.1), score ≤4: 8.4% (95% CI, 6.1–10.6), as did excluding studies with n

ABSTRACTBackground Healthcare access for chronic low back pain is complex and should consider not only the health system, but patient care seeking experiences as well. People who live in rural and remote communities and/or identify as being Indigenous may often encounter additional barriers to accessing care for chronic low back pain; thus, these contexts must be considered to fully understand barriers and facilitators.Aims The aim of this study was to understand care-seeking experiences of people living with chronic back pain in Saskatchewan and determine unique experiences facing urban, rural, remote, and/or Indigenous peoples.Methods Thirty-three participants with chronic low back pain completed a preliminary survey followed by individual semistructured interviews. Participants were categorized as urban, rural, or remote including Indigenous status. A qualitative interpretive research approach with inductive thematic analysis was employed.Results Three overarching themes were identified with the following subthemes: (1) healthcare access challenges: challenges to accessing care, challenges within the health system, and challenges leading to self-directed management/coping strategies; (2) healthcare access facilitators: funded care, participant education and knowledge, patient–provider communication, and care closer to home; and (3) participant recommendations for improved care provision: coordination of care, integrative and holistic care, and patient-centered care and support. Rural and remote participants highlighted travel as a main barrier. Indigenous participant experiences emphasized communication with healthcare providers and past experiences influencing desire to access care.Conclusion Participants identified a range of challenges and facilitators as well as recommendations for improving access to care for chronic low back pain, with unique barriers for rural, remote, and Indigenous participants.

Introduction Trauma contributes to the greatest loss of disability-adjusted life-years for adolescents and young adults worldwide. In the context of global abdominal trauma, the trauma laparotomy is the most commonly performed operation. Variation likely exists in how these patients are managed and their subsequent outcomes, yet very little global data on the topic currently exists. The objective of the GOAL-Trauma study is to evaluate both patient and injury factors for those undergoing trauma laparotomy, their clinical management and postoperative outcomes.Methods We describe a planned prospective multicentre observational cohort study of patients undergoing trauma laparotomy. We will include patients of all ages who present to hospital with a blunt or penetrating injury and undergo a trauma laparotomy within 5 days of presentation to the treating centre. The study will collect system, patient, process and outcome data, following patients up until 30 days postoperatively (or until discharge or death, whichever is first). Our sample size calculation suggests we will need to recruit 552 patients from approximately 150 recruiting centres.Discussion The GOAL-Trauma study will provide a global snapshot of the current management and outcomes for patients undergoing a trauma laparotomy. It will also provide insight into the variation seen in the time delays for receiving care, the disease and patient factors present, and patient outcomes. For current standards of trauma care to be improved worldwide, a greater understanding of the current state of trauma laparotomy care is paramount if appropriate interventions and targets are to be identified and implemented.

Left subclavian artery revascularization at the time of thoracic endovascular aortic repair has been the subject of discussion for over a decade. Contemporary viewpoints suggest that revascularization should be performed where possible to decrease the risk of perioperative stroke, spinal cord ischemia, and, to a lesser degree, loss of upper extremity function. In this article, we present traditional methods as well as descriptions of newer options and technology for preservation of left subclavian artery flow during thoracic endovascular aortic repair.

While growing awareness of the unmet mental health needs of LGBTQ youth populations has prompted calls for greater emphasis on health equity, efforts have largely overlooked glaring inequities affecting LGBTQ youth who become involved with the justice system. The disproportionality of juvenile justice system involvement for LGTBQ youth is a public health concern that merits focused attention and advocacy from child and adolescent mental health professionals. The proportion of incarcerated youth in the juvenile justice system who are LGBTQ is twice that of LGBTQ youth in the general adolescent population.1 Disparities are even more pronounced for girls-40% of incarcerated girls identify as LGB and/or report same-sex attraction.2 Furthermore, gender and sexuality dimensions intersect with racial and ethnic identities for many youth involved in the justice system. In fact, 85%-90% of incarcerated LGBTQ youth are from ethnic or racial minority backgrounds.2,3 Thus, we call for attentiveness to the intersectional inequities facing LGBTQ youth involved in the justice system and offer solutions for improving their mental health outcomes. Child and adolescent mental health professionals can change trajectories of LGBTQ youth through clinical work that addresses modifiable risk factors facing LGBTQ youth, targeted research efforts on the experiences of LGBTQ youth in justice settings as well as intervention studies, and legislative advocacy that provides protective and appropriate services to LGBTQ youth across various justice system touchpoints.

Separating children from families has deleterious effects on childrens mental health and well-being, which is highly relevant for youth in juvenile detention and other out-of-home residential placements. Despite growth in the evidence of family-based interventions in mitigating adverse behavioral health outcomes for justice involved adolescents (JIA), gaps remain in intervention dissemination for JIA; this particularly true for those leveraging digital health technologies, a need that has intensified with the COVID-19 pandemic. Use of digital health technologies for JIAs is pressing to address structural barriers in maintaining JIA-family connections, but also to improve treatment access for detained JIAs. Court systems capacity to support use of digital health tools, such as telehealth, appear promising. Data on the use of tele-conferencing in U.S. juvenile and family courts were collected from 456 juvenile justice professionals as part of a larger study on judicial decision making. Results suggest overwhelming adoption of video-conferencing for court hearings with only 40% of respondents reporting family court use prior to the onset of COVID-19, but majority (91%) now reporting its routine use. Youth participate from a range of settings, including detention, other residential placement, community-based behavioral health and in-home settings. The COVID-19 pandemic has created a shift in the uptake of video-conferencing platforms that could hold promise for future larger scale use across the juvenile justice system. Findings underscore feasibility and acceptability of technology requirements in key settings that should be leveraged for broad scale implementation of empirically supported family-based interventions to advance behavioral health equity for JIA.

The woefully low proportion of scientists and clinicians underrepresented in medicine (UIM), including members of African-American/Black, Hispanic/Latinx, American Indian/Alaska Native or Native Hawaiian/Pacific Islander communities, is well characterized and documented. Diversity in medicine is not only just, but it improves quality and outcomes. Yet, diversity in academic medicine remains stagnant, despite national recognition and urgent calls to improve diversity, equity, and inclusion across health sciences. One strategy that has shown to improve diversity in many sectors is high quality mentoring. While many institutions have adopted mentoring programs, there remains a lack of mentorship that is equitable, individualized, and sets a clear timeline for academic milestones that will position UIM mentees at the optimal trajectory for promotion and retention. A barrier to assembling these programs is the small number of UIM among the senior faculty ranks who are able to serve in this role, given the disproportionate burden to serve on a multitude of academic committees, task forces, and workgroups to fulfill institutional mandates to diversify representation. These time-consuming services, documented in the literature as the "minority tax," are generally uncompensated and unaccounted for in terms of consideration for promotion, leadership positions, and other measures of career advancement. The Justice, Equity, Diversity, and Inclusion Academic Mentors (JAM) Council represents a novel, culturally responsive, and anti-racist approach to achieve a more equitable and inclusive institutional environment. This approach strategically leverages the intergenerational wisdom and experience of senior UIM faculty via time-protected effort with the overall goals of improving rates of promotion, retention, and career satisfaction of early career UIM colleagues. This community case study describes the rationale, resources needed, processes, and proposed workflow required to launch the JAM Council, as well as the major roles and responsibilities for JAM mentors and mentees, which may be considered by academic medical centers focused on improving diversity among the faculty ranks.

While the number of positions, committees, and projects described as "Diversity, Equity, and Inclusion (DEI)" work has grown rapidly in recent years, there has been little attention to the theory, praxis, or lived experience of this work. In this perspective, we briefly summarize the research and concepts put forth by DEI leaders in higher education more broadly, followed by an analysis of the literature's application to academic medicine. We then discuss the ways in which language obscures the nature of DEI and the necessity of scholarship to evaluate the extensive range of practices, policies, statements, and programs the label is given to.

ObjectiveTo summarise evidence of the effects of blood pressure (BP)-lowering interventions after acute spontaneous intracerebral haemorrhage (ICH).MethodsA prespecified systematic review of the Cochrane Central Register of Controlled Trials, EMBASE and MEDLINE databases from inception to 23 June 2020 to identify randomised controlled trials that compared active BP-lowering agents versus placebo or intensive versus guideline BP-lowering targets for adults 6 mL) and proportional (>33%) haematoma growth at 24 hours. Meta-analysis used a one-stage approach, adjusted using generalised linear mixed models with prespecified covariables and trial as a random effect.ResultsOf 7094 studies identified, 50 trials involving 11 494 patients were eligible and 16 (32.0%) shared patient-level data from 6221 (54.1%) patients (mean age 64.2 [SD 12.9], 2266 [36.4%] females) with a median time from symptom onset to randomisation of 3.8 hours (IQR 2.6-5.3). Active/intensive BP-lowering interventions had no effect on the primary outcome compared with placebo/guideline treatment (adjusted OR for unfavourable shift in modified Rankin scale scores: 0.97, 95% CI 0.88 to 1.06; p=0.50), but there was significant heterogeneity by strategy (pinteraction=0.031) and agent (pinteraction6 ml, adjusted OR 0.75, 95%CI 0.60 to 0.92; p=0.0077) and relative (≥33%, adjusted OR 0.82, 95%CI 0.68 to 0.99; p=0.034) haematoma growth.InterpretationOverall, a broad range of interventions to lower BP within 7 days of ICH onset had no overall benefit on functional recovery, despite reducing bleeding. The treatment effect appeared to vary according to strategy and agent.Prospero registration numberCRD42019141136.

Autism spectrum disorder (ASD) impacts an individual's ability to socialize, communicate, and interact with, and adapt to, the environment. Over the last two decades, research has focused on early identification of ASD with significant progress being made in understanding the early behavioral and biological markers that precede a diagnosis, providing a catalyst for pre-symptomatic identification and intervention. Evidence from preclinical trials suggest that intervention prior to the onset of ASD symptoms may yield more improved developmental outcomes, and clinical studies suggest that the earlier intervention is administered, the better the outcomes. This article brings together a multidisciplinary group of experts to develop a conceptual framework for behavioral intervention, during the pre-symptomatic period prior to the consolidation of symptoms into diagnosis, in infants at very-high-likelihood for developing ASD (VHL-ASD). The overarching goals of this paper are to promote the development of new intervention approaches, empirical research, and policy efforts aimed at VHL-ASD infants during the pre-symptomatic period (i.e., prior to the consolidation of the defining features of ASD).

The diagnostic value of imaging Aβ plaques in Alzheimer’s disease (AD) has accelerated the development of fluorine-18 labeled radiotracers with a longer half-life for easier translation to clinical use. We have developed [18F]flotaza, which shows high binding to Aβ plaques in postmortem human AD brain slices with low white matter binding. We report the binding of [18F]flotaza in postmortem AD hippocampus compared to cognitively normal (CN) brains and the evaluation of [18F]flotaza in transgenic 5xFAD mice expressing Aβ plaques. [18F]Flotaza binding was assessed in well-characterized human postmortem brain tissue sections consisting of HP CA1-subiculum (HP CA1-SUB) regions in AD (n = 28; 13 male and 15 female) and CN subjects (n = 32; 16 male and 16 female). Adjacent slices were immunostained with anti-Aβ and analyzed using QuPath. In vitro and in vivo [18F]flotaza PET/CT studies were carried out in 5xFAD mice. Post-mortem human brain slices from all AD subjects were positively IHC stained with anti-Aβ. High [18F]flotaza binding was measured in the HP CA1-SUB grey matter (GM) regions compared to white matter (WM) of AD subjects with GM/WM > 100 in some subjects. The majority of CN subjects had no decipherable binding. Male AD exhibited greater WM than AD females (AD WM♂/WM♀ > 5; p < 0.001) but no difference amongst CN WM. In vitro studies in 5xFAD mice brain slices exhibited high binding [18F]flotaza ratios (>50 versus cerebellum) in the cortex, HP, and thalamus. In vivo, PET [18F]flotaza exhibited binding to Aβ plaques in 5xFAD mice with SUVR~1.4. [18F]Flotaza is a new Aβ plaque PET imaging agent that exhibited high binding to Aβ plaques in postmortem human AD. Along with the promising results in 5xFAD mice, the translation of [18F]flotaza to human PET studies may be worthwhile.

The purpose of this scoping literature review was to examine research on police involvement in school mental health crisis response. The search was conducted in PsychInfo, PubMed, and ERIC and initially identified 315 articles. After applying inclusion/exclusion criteria, 47 articles remained. Detailed review and data extraction by three independent reviewers resulted in a final article count of nine. Three primary themes were identified across articles: (1) perceptions and consequences of law enforcement presence in schools; (2) the role of school-community partnerships in successful crisis response models; and (3) gaps in research and challenges of implementing and scaling existing models. Though in practice law enforcement officers are often involved in school mental health crisis response, there is limited empirical research supporting this approach. Our review did not return any randomized trials. In the absence of empirical evidence supporting the use of current models, there is a need for research on law enforcement involvement in school crisis response and, more broadly, community-partnered models of responding to student mental health needs.

BackgroundBlockchain distributed ledger technology is just starting to be adopted in genomics and healthcare applications. Despite its increased prevalence in biomedical research applications, skepticism regarding the practicality of blockchain technology for real-world problems is still strong and there are few implementations beyond proof-of-concept. We focus on benchmarking blockchain strategies applied to distributed methods for sharing records of gene-drug interactions. We expect this type of sharing will expedite personalized medicine.Basic proceduresWe generated gene-drug interaction test datasets using the Clinical Pharmacogenetics Implementation Consortium (CPIC) resource. We developed three blockchain-based methods to share patient records on gene-drug interactions: Query Index, Index Everything, and Dual-Scenario Indexing.Main findingsWe achieved a runtime of about 60 s for importing 4,000 gene-drug interaction records from four sites, and about 0.5 s for a data retrieval query. Our results demonstrated that it is feasible to leverage blockchain as a new platform to share data among institutions.Principal conclusionsWe show the benchmarking results of novel blockchain-based methods for institutions to share patient outcomes related to gene-drug interactions. Our findings support blockchain utilization in healthcare, genomic and biomedical applications. The source code is publicly available at https://github.com/tsungtingkuo/genedrug.

Abstract Intensive antiplatelet therapy did not reduce recurrent stroke/transient ischaemic attack (TIA) events as compared with guideline treatment in the Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (TARDIS) trial, but did increase the frequency and severity of bleeding. In this pre-specified analysis, we investigated predictors of bleeding and the association of bleeding with outcome. TARDIS was an international prospective randomised open-label blinded-endpoint trial in participants with ischaemic stroke or TIA within 48 h of onset. Participants were randomised to 30 days of intensive antiplatelet therapy (aspirin, clopidogrel, dipyridamole) or guideline-based therapy (either clopidogrel alone or combined aspirin and dipyridamole). Bleeding was defined using the International Society on Thrombosis and Haemostasis five-level ordered categorical scale: fatal, major, moderate, minor, none. Of 3,096 participants, bleeding severity was: fatal 0.4%, major 1.5%, moderate 1.2%, minor 11.4%, none 85.5%. Major/fatal bleeding was increased with intensive as compared with guideline therapy: 39 vs. 17 participants, adjusted hazard ratio 2.21, 95% CI 1.24–3.93, p = 0.007. Bleeding events diverged between treatment groups in the 8–35 day period but not in the 0–7 or 36–90 day epochs. In multivariate analysis more, and more severe, bleeding events were seen with increasing age, female sex, pre-morbid dependency, increased time to randomisation, prior major bleed, prior antiplatelet therapy and in those randomised to triple vs guideline antiplatelet therapy. More severe bleeding was associated with worse clinical outcomes across multiple physical, emotional and quality of life domains. Trial registration ISRCTN47823388 .

Abstract Objective Software developed using artificial intelligence may automatically identify arterial occlusion and provide collateral vessel scoring on CT angiography (CTA) performed acutely for ischemic stroke. We aimed to assess the diagnostic accuracy of e‐CTA by Brainomix™ Ltd by large‐scale independent testing using expert reading as the reference standard. Methods We identified a large clinically representative sample of baseline CTA from 6 studies that recruited patients with acute stroke symptoms involving any arterial territory. We compared e‐CTA results with masked expert interpretation of the same scans for the presence and location of laterality‐matched arterial occlusion and/or abnormal collateral score combined into a single measure of arterial abnormality. We tested the diagnostic accuracy of e‐CTA for identifying any arterial abnormality (and in a sensitivity analysis compliant with the manufacturer's guidance that software only be used to assess the anterior circulation). Results We include CTA from 668 patients (50% female; median: age 71 years, NIHSS 9, 2.3 h from stroke onset). Experts identified arterial occlusion in 365 patients (55%); most (343, 94%) involved the anterior circulation. Software successfully processed 545/668 (82%) CTAs. The sensitivity, specificity and diagnostic accuracy of e‐CTA for detecting arterial abnormality were each 72% (95% CI = 66–77%). Diagnostic accuracy was non‐significantly improved in a sensitivity analysis excluding occlusions from outside the anterior circulation (76%, 95% CI = 72–80%). Interpretation Compared to experts, the diagnostic accuracy of e‐CTA for identifying acute arterial abnormality was 72–76%. Users of e‐CTA should be competent in CTA interpretation to ensure all potential thrombectomy candidates are identified.

Abstract Background Management of mechanically ventilated patients can be improved with monitoring of key pulmonary function parameters that facilitate individualization and optimization. The VQm Pulmonary Health Monitor™ (PHM) (Rostrum Medical Innovations Inc., Vancouver, Canada) is a new monitor that continuously measures pulmonary blood flow (PBF), functional residual capacity (FRC) and a novel parameter: shunt index (Qsi). The goal of this study was to provide an initial assessment of the performance of the VQm PHM™ when compared with reference measures of PBF, FRC and intra-pulmonary shunt. Methods This was a prospective, experimental, large animal (porcine) study. After baseline measurements, three interventions were performed: increased cardiac output (CO) using dobutamine infusion, increased PEEP (from 4 to 12 cmH2O), and experimental shunt induced by an extracorporeal circuit. PBF, FRC and shunt were measured by the VQm Pulmonary Health Monitor™ (PHM) before and after each intervention. The PHM™ uses sequential gas delivery to deliver targeted alveolar concentrations of CO2 or N2O. PBF and FRC were calculated using CO2 bolus delivery and the modified differential Fick equation. Shunt was estimated from the number of breaths required to eliminate N2O after a 25-breath N2O bolus and expressed as Qsi. PHM™-derived PBF and Qsi were compared to thermodilution CO and calculated Berggren shunt, respectively. Results Studies were completed in 19 animals. Measurements of PBF, FRC and Qsi obtained from the PHM™ trended as expected following each intervention. The mean difference between paired values of PBF was − 0.2 ± 0.9 L/min and the 95% limits of agreement were 1.5 and − 1.9 L/min. Concordance was 94.1%. The mean baseline FRC was 1.7 $$\pm$$ 0.4 L and increased to 2.0 $$\pm$$ 0.6 L, following the increase in PEEP (p = 0.0078). For shunt (Qsi), the mean values during low (1 L/min) and high (50% of baseline CO) shunt value were 40 $$\pm$$ 4 and 27 $$\pm$$ 5, respectively, p = 0.002. Conclusions PBF obtained through the modified differential Fick equation and Qsi obtained through N2O uptake and decay dynamics by the VQm PHM™ provide comparable results to reference standards. FRC measurements trended as expected following interventions.

O objetivo deste trabalho foi relatar casos clínicos de Mycoplasma sp. em quatro porquinhos-da-índia (Cavia porcellus). A micoplasmose é uma bactéria da classe Mollicutes que causa infecções de relevância na medicina veterinária, já tendo sido observada em diversas espécies de animais. Neste caso, a queixa principal apresentada foi referente a respiração ofegante e espirros apresentados pelos quatro animais relatados. Durante a anamnese também foi relatado que os pais dos pacientes já haviam sido testados positivos para Mycoplasma sp. No exame físico foi observado ausculta pulmonar com sibilo, taquipneia e letargia. Eles foram encaminhados para internação para estabilização do quadro, onde foram administrados antibióticos (por via oral e via inalatória) e anti-inflamatório esteroidal de ação local (por via inalatória). Foi realizado PCR (Reação de Polimerização em Cadeia) qualitativo para Mycoplasma sp., em amostra de fezes, na tentativa de fechar um diagnóstico. Após melhora do quadro, os pacientes receberam alta para continuidade do tratamento em casa. Foi feita uma consulta de retorno depois de cinco dias para uma reavaliação. Os animais estavam estáveis e com a ausculta pulmonar limpa. O PCR confirmou a suspeita de micoplasma, tendo todos testados positivos. Após o fechamento do diagnóstico, foi realizado protocolo mensal com Pulmotil™ AC (tilmicosina) (10 mg/kg/SID/ cinco dias/mensal/água de bebida). Após o início do protocolo, os pacientes apresentaram melhora, retornando ao hospital apenas para consultas de acompanhamento. O uso mensal do Pulmotil™ AC (tilmicosina) se mostrou efetivo na redução dos sinais clínicos causados pela Mycoplasma sp e os animais não apresentaram mais a forma sintomática da doença.

Introduction: Cognitive decline and mood disorders are two major concerns of people affected by stroke. The extent to which cognition and mood relate to or are independent of stroke severity and post-stroke dependency are unclear. We examined the associations between stroke severity, global measures of cognition, mood and dependency up to 14-weeks post-stroke in a large national study of neurocognitive complications of stroke up to two years, the Rates, Risks and Routes to Reduce Vascular Dementia (R4VaD) study. Methods: R4VaD recruited patients with stroke of all subtypes and severities and collected clinical, cognitive and mood data at baseline (within six-weeks post-stroke), subacutely (6+/-2 weeks later; ie. maximum 14-weeks post-stroke) and 1 and 2 years. We measured baseline stroke severity (National Institute of Health Stroke Scale, NIHSS), pre-stroke and 14-week dependency (Modified Rankin Scale, mRS), cognition (Montreal Cognitive Assessment, MoCA; Modified Telephone Interview for Cognitive Status, TICS-m), and mood (Zung depression scale; Patient Health Questionnaire, PHQ; General Anxiety Disorder scale, GAD-7). We analysed baseline and 14-week cognition and mood using linear models with log-transformed NIHSS, adjusted for mRS, age, sex, education, hypertension, diabetes and smoking. Results: We recruited 2441 participants (mean age=68.2 SD=13.5; 40% female; median NIHSS=2.0, IQR=0-4, range=0-24; median stroke onset to recruitment=6 days, IQR=3-13; median time to follow-up=6.6 weeks, IQR=6.0-7.9). Table 1 shows baseline and subacute cognition and mood scores. At baseline higher NIHSS associated with lower cognition (MoCA: β= -0.22, p

ObjectiveTo utilize, in an individual and institutional privacy-preserving manner, electronic health record (EHR) data from 202 hospitals by analyzing answers to COVID-19-related questions and posting these answers online.Materials and methodsWe developed a distributed, federated network of 12 health systems that harmonized their EHRs and submitted aggregate answers to consortia questions posted at https://www.covid19questions.org. Our consortium developed processes and implemented distributed algorithms to produce answers to a variety of questions. We were able to generate counts, descriptive statistics, and build a multivariate, iterative regression model without centralizing individual-level data.ResultsOur public website contains answers to various clinical questions, a web form for users to ask questions in natural language, and a list of items that are currently pending responses. The results show, for example, that patients who were taking angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, within the year before admission, had lower unadjusted in-hospital mortality rates. We also showed that, when adjusted for, age, sex, and ethnicity were not significantly associated with mortality. We demonstrated that it is possible to answer questions about COVID-19 using EHR data from systems that have different policies and must follow various regulations, without moving data out of their health systems.Discussion and conclusionsWe present an alternative or a complement to centralized COVID-19 registries of EHR data. We can use multivariate distributed logistic regression on observations recorded in the process of care to generate results without transferring individual-level data outside the health systems.

Omics experiments are ubiquitous in biological studies, leading to a deluge of data. However, it is still challenging to connect changes in these data to changes in cell functions because of complex interdependencies between genes, proteins, and metabolites. Here, we present a framework allowing researchers to infer how metabolic functions change on the basis of omics data. To enable this, we curated and standardized lists of metabolic tasks that mammalian cells can accomplish. Genome-scale metabolic networks were used to define gene sets associated with each metabolic task. We further developed a framework to overlay omics data on these sets and predict pathway usage for each metabolic task. We demonstrated how this approach can be used to quantify metabolic functions of diverse biological samples from the single cell to whole tissues and organs by using multiple transcriptomic datasets. To facilitate its adoption, we integrated the approach into GenePattern (www.genepattern.org-CellFie).

PurposeThe evidence for the effectiveness of outpatient treatment of low-risk patients with acute pulmonary embolism (PE) continues to mount. However, lack of definitional clarity may hinder understanding of this emerging management strategy and impede translation into clinical practice. We describe the range of definitions provided in the primary outpatient PE literature.MethodsWe undertook a narrative review of the English-language medical literature indexed in PubMed and Embase through the end of 2019. We identified studies of outpatient treatment of patients with acute PE.ResultsFifty-one studies met our criteria. All studies provided some degree of definition of "outpatient," even if implicit or broad. Forty-six studies (90%) reported 1 or 2 sites of patient discharge (or departure) to home: emergency department (ED)/ambulatory care unit (n = 31), inpatient ward (n = 13), and secondary care clinic (n = 8). Of the 31 ED-based studies, 9 (29%) delimited duration of care (from < 24 to < 48 hours). All inpatient studies placed an outer boundary on the time to discharge within their definition of outpatient care.ConclusionDefinitions of outpatient care in the PE literature vary considerably. The sites, duration, and intensity of care involved in outpatient PE management prior to home discharge range from comprehensive specialty clinic care to an ED evaluation, sometimes coupled with 1 to 5 days of additional inpatient care. Research on the outpatient management of acute PE would benefit from greater definitional clarity as clinicians, departments, and health systems seek to translate this research into real-world clinical practice.

OBJECTIVE: Justice-involved youth report high rates of adverse childhood experiences (ACEs; abuse, neglect, household dysfunction) and are at high risk for elevated behavioral health needs (i.e., substance use, psychiatric symptoms). Research with broad samples of adolescents shows ACEs predict behavioral health outcomes, yet most research on the impact of ACEs among justice-involved youth focuses on recidivism. The present study addresses this gap by examining the prospective association between ACEs and psychiatric symptoms, substance use, and substance-related problems (i.e., consequences of use) among first-time justice-involved youth. METHOD: First-time justice-involved youth (n = 271; 54.3% male; M age = 14.5 years; 43.5% Latinx; non-Latinx: 34.2% White, 8.6% Black, 7.1% Other, 6.7% Multiracial) and their caregivers were assessed at youths first court contact and 4- and 12-month follow-ups. Youth and caregivers reported youths exposure to ACEs through a series of instruments at baseline and 4-months (e.g., Childhood Trauma Questionnaire Short-Form; Traumatic Life Events Inventory). Primary outcomes included youth alcohol and cannabis use (Adolescent Risk Behavior Assessment), consequences of use (Brief Young Adult Alcohol Consequences Questionnaire; Brief Marijuana Consequences Scale), and psychiatric symptoms (Behavior Assessment System for Children; National Stressful Events Survey PTSD Short Scale). RESULTS: Youth were exposed to three ACEs, on average, prior to first justice contact (M = 3). Exposure to more ACEs, particularly abuse, predicted substance use and psychiatric outcomes. Gender differences emerged for cannabis use and internalizing symptoms. CONCLUSIONS: Implications for trauma-responsive juvenile justice reform are discussed, including screening for ACEs and their sequelae at first court contact and considering the role of masculine norms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).