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Background Tiered trauma team activation (TTA) allows systems to optimally allocate resources to an injured patient. Target undertriage and overtriage rates of

The NIH-funded RECOVER study is collecting clinical data on patients who experience a SARS-CoV-2 infection. As patient representatives of the RECOVER Initiative’s Mechanistic Pathways task force, we offer our perspectives on patient motivations for partnering with researchers to obtain results from mechanistic studies. We emphasize the challenges of balancing urgency with scientific rigor. We recognize the importance of such partnerships in addressing post-acute sequelae of SARS-CoV-2 infection (PASC), which includes ‘long COVID,’ through contrasting objective and subjective narratives. Long COVID’s prevalence served as a call to action for patients like us to become actively involved in efforts to understand our condition. Patient-centered and patient-partnered research informs the balance between urgency and robust mechanistic research. Results from collaborating on protocol design, diverse patient inclusion, and awareness of community concerns establish a new precedent in biomedical research study design. With a public health matter as pressing as the long-term complications that can emerge after SARS-CoV-2 infection, considerate and equitable stakeholder involvement is essential to guiding seminal research. Discussions in the RECOVER Mechanistic Pathways task force gave rise to this commentary as well as other review articles on the current scientific understanding of PASC mechanisms.

BackgroundThe implementation of deep learning models for medical image classification poses significant challenges, including gradual performance degradation and limited adaptability to new diseases. However, frequent retraining of models is unfeasible and raises concerns about healthcare privacy due to the retention of prior patient data. To address these issues, this study investigated privacy-preserving continual learning methods as an alternative solution.MethodsWe evaluated twelve privacy-preserving non-storage continual learning algorithms based deep learning models for classifying retinal diseases from public optical coherence tomography (OCT) images, in a class-incremental learning scenario. The OCT dataset comprises 108,309 OCT images. Its classes include normal (47.21%), drusen (7.96%), choroidal neovascularization (CNV) (34.35%), and diabetic macular edema (DME) (10.48%). Each class consisted of 250 testing images. For continuous training, the first task involved CNV and normal classes, the second task focused on DME class, and the third task included drusen class. All selected algorithms were further experimented with different training sequence combinations. The final model's average class accuracy was measured. The performance of the joint model obtained through retraining and the original finetune model without continual learning algorithms were compared. Additionally, a publicly available medical dataset for colon cancer detection based on histology slides was selected as a proof of concept, while the CIFAR10 dataset was included as the continual learning benchmark.ResultsAmong the continual learning algorithms, Brain-inspired-replay (BIR) outperformed the others in the continual learning-based classification of retinal diseases from OCT images, achieving an accuracy of 62.00% (95% confidence interval: 59.36-64.64%), with consistent top performance observed in different training sequences. For colon cancer histology classification, Efficient Feature Transformations (EFT) attained the highest accuracy of 66.82% (95% confidence interval: 64.23-69.42%). In comparison, the joint model achieved accuracies of 90.76% and 89.28%, respectively. The finetune model demonstrated catastrophic forgetting in both datasets.ConclusionAlthough the joint retraining model exhibited superior performance, continual learning holds promise in mitigating catastrophic forgetting and facilitating continual model updates while preserving privacy in healthcare deep learning models. Thus, it presents a highly promising solution for the long-term clinical deployment of such models.

The COVID-19 global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has infected hundreds of millions of individuals. Following COVID-19 infection, a subset can develop a wide range of chronic symptoms affecting diverse organ systems referred to as post-acute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. A National Institutes of Health-sponsored initiative, RECOVER: Researching COVID to Enhance Recovery, has sought to understand the basis of long COVID in a large cohort. Given the range of symptoms that occur in long COVID, the mechanisms that may underlie these diverse symptoms may also be diverse. In this review, we focus on the emerging literature supporting the role(s) that viral persistence or reactivation of viruses may play in PASC. Persistence of SARS-CoV-2 RNA or antigens is reported in some organs, yet the mechanism by which they do so and how they may be associated with pathogenic immune responses is unclear. Understanding the mechanisms of persistence of RNA, antigen or other reactivated viruses and how they may relate to specific inflammatory responses that drive symptoms of PASC may provide a rationale for treatment.

BackgroundPre-exposure prophylaxis for COVID-19 with tixagevimab/cilgavimab (T/C) received Emergency Use Authorization (EUA) based on results of a clinical trial conducted prior to the emergence of the Omicron variant. The clinical effectiveness of T/C has not been well described in the Omicron era. We examined the incidence of symptomatic illness and hospitalizations among T/C recipients when Omicron accounted for virtually all local cases.MethodsThrough retrospective electronic medical record chart review, we identified patients who received T/C between January 1 -July 31, 2022 within our quaternary referral health system. We determined the incidence of symptomatic COVID-19 infections and hospitalizations due to or presumed to be caused by early Omicron variants before and after receiving T/C (pre-T/C and post-T/C). Chi square and Mann-Whitney Wilcoxon two-sample tests were used to examine differences between the characteristics of those who got COVID-19 before or after T/C prophylaxis, and rate ratios (RR) and 95% confidence intervals (CI) were calculated to assess differences in hospitalization rates for the two groups.ResultsOf 1295 T/C recipients, 105 (8.1%) developed symptomatic COVID-19 infection before receiving T/C, and 102 (7.9%) developed symptomatic disease after receiving it. Of the 105 patients who developed symptomatic infection pre-T/C, 26 (24.8%) were hospitalized, compared with six of the 102 patients (5.9%) who were diagnosed with COVID-19 post-T/C (RR = 0.24; 95% CI = 0.10-0.55; p = 0.0002). Seven of the 105 (6.7%) patients infected pre-T/C, but none of the 102 infected post-T/C required ICU care. No COVID-related deaths occurred in either group. The majority of COVID-19 cases among those infected pre-T/C treatment occurred during the Omicron BA.1 surge, while the majority of post-T/C cases occurred when Omicron BA.5 was predominant. In both groups, having at least one dose of vaccine strongly protected against hospitalization (pre-T/C group RR = 0.31, 95% CI = 0.17-0.57, p = 0.02; post-T/C group RR = 0.15; 95% CI = 0.03-0.94; p = 0.04).ConclusionWe identified COVID-19 infections after T/C prophylaxis. Among patients who received T/C at our institution, COVID-19 Omicron cases occurring after T/C were one-fourth as likely to require hospitalization compared to those with Omicron prior to T/C. However, due to the presence of changing vaccine coverage, multiple therapies, and changing variants, the effectiveness of T/C in the Omicron era remains difficult to assess.

Mycobacterium haemophilum is an increasingly recognized pathogen of the non-tuberculous mycobacteria family that largely infects immunocompromised adults and immunocompetent children. M. haemophilum is a fastidious and slow-growing organism that exhibits preferential growth at lower temperature with iron supplemented media, and therefore most clinical manifestations involve cutaneous infection or musculoskeletal infection of the distal extremities. It is believed that opportunistic infection occurs in immunocompromised hosts when the organism is acquired through environmental exposure. We describe the case of a 71-year-old renal transplant recipient who developed acute M. haemophilum osteomyelitis of the left foot, likely contracted from Epsom salt soaks with contaminated tap water. Outcomes of M. haemophilum infection are generally favorable in the literature. Our patient was treated with local debridement and partial amputation followed by a 3-drug anti-mycobacterial regimen until definitive amputation could be completed.

Lung cancer is one of the major causes of cancer-related deaths worldwide, primarily because of the limitations of conventional clinical therapies such as chemotherapy and radiation therapy. Side effects associated with these treatments have made it essential for new modalities, such as tumor targeting nanoparticles that can provide cancer specific therapies. In this research, we have developed novel dual-stimuli nanoparticles (E-DSNPs), comprised of two parts; (1) Core: responsive to glutathione as stimuli and encapsulating Cisplatin (a chemo-drug), and (2) Shell: responsive to irradiation as stimuli and containing NU7441 (a radiation sensitizer). The targeting moieties on these nanoparticles are Ephrin transmembrane receptors A2 (EphA2) that are highly expressed on the surfaces of lung cancer cells. These nanoparticles were then evaluated for their enhanced targeting and therapeutic efficiency against lung cancer cell lines. E-DSNPs displayed very high uptake by lung cancer cells compared to healthy lung epithelial cells. These nanoparticles also demonstrated a triggered release of both drugs against respective stimuli and a subsequent reduction in in vitro cancer cell survival fraction compared to free drugs of equivalent concentration (survival fraction of about 0.019 and 0.19, respectively). Thus, these nanoparticles could potentially pave the path to targeted cancer therapy, while overcoming the side effects of conventional clinical therapies.

A 65-year-old woman with chronic osteoarthritis of the knees presented with a one-week history of acutely worsening right knee pain and swelling. Arthrocentesis was performed and synovial fluid was indicative of septic arthritis with a negative Gram stain for bacteria. Magnetic Resonance Imaging (MRI) was obtained, revealing a large anterior periarticular abscess with concomitant septic arthritis. Orthopedic surgeons performed urgent incision and drainage of the abscess and washout of the joint. Synovial fluid culture grew Kingella kingae and the patient was treated with four weeks of ceftriaxone with improvement in both clinical symptoms and laboratory values. Kingella kingae is a common cause of pediatric bone and joint infection but remains an exceedingly rare cause of native joint septic arthritis among immunocompetent adults. Kingella spp are largely susceptible to beta-lactam antimicrobials.

Experience with visual stimuli can improve their perceptual performance, a phenomenon termed visual perceptual learning (VPL). VPL has been found to improve metacognitive measures, suggesting increased conscious accessibility to the knowledge supporting perceptual decision-making. However, such studies have largely failed to control objective task accuracy, which typically correlates with metacognition. Here, using a staircase method to control this confound, we investigated whether VPL improves the metacognitive accuracy of perceptual decision-making. Across 3 days, subjects were trained to discriminate faces based on their high-level identity or low-level contrast. Holding objective accuracy constant across training days, perceptual thresholds decreased in both tasks, demonstrating VPL in our protocol. However, whilemetacognitive accuracy was not affected by face contrast VPL, it was decreased by face identity VPL. Our findings couldbe parsimoniously explained by a dual-stage signal detection theory-based model involving an initial perceptual decision-making stage and a second confidence judgment stage. Within this model, internal noise reductions for both stages accounts for our face contrast VPL result, while only first stage noise reductions accounts for our face identity VPL result. In summary, we found evidence suggesting that conscious knowledge accessibility was improved by the VPL of face contrast but not face identity.

Medical scientist trainees who take extended scholarly time in the middle of their training experience challenges during transitions in training. As they complete their dissertation and re-enter the clinical years of medical school, there is marked by a loss of clinical knowledge and skills over a prolonged hiatus from medicine and mismatched expectations. We have developed a re-entry pathway including guidance, support, and a course to provide clinical skills and knowledge training to align expectations, dispel myths, and allow advanced planning to meet milestones. Students reporting satisfaction with their transition from PhD to MD3 and 90% of students reported that the pathway was valuable. We provide 12 tips on how to improve the transition from research to clinical training. Here we demonstrate that a planned pathway for the transition back to medical training can improve the student-mentor experience, reduce anxiety, and create a more seamless and successful transition.

Metallic molybdenum disulfide is a metastable phase of the material. Here, the authors synthesize two-dimensional metallic molybdenum disulfide nanosheets, stabilized by adsorbed aqueous monolayers, and evaluate their catalytic hydrogen evolution activity.

This paper concerns a formula which relates the Lefschetz number for a map to the fixed point index summed with the fixed point index of a derived map on part of the boundary of . Here is a compact manifold and is with a collar attached.