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Objective The aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London.Design Observational cohort study.Setting London North West Healthcare NHS Trust (LNWH).Participants Patients tested and/or admitted for COVID-19 at LNWH during March and April 2020Main outcome measures Descriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19.Results The outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p

OBJECTIVES: The Salivary Gland Committee of the American Academy of Otolaryngology-Head and Neck Surgery seeks to standardize terminology and technique for ultrasonograpy used in the evaluation and treatment of salivary gland disorders. METHODS: Development of expert opinion obtained through interaction with international practitioners representing multiple specialties. This committee work includes a comprehensive literature review with presentation of case examples to propose a standardized protocol for the language used in ultrasound salivary gland assessment. RESULTS: A multiple segment proposal is initiated with this focus on the submandibular gland. We provide a concise rationale for recommended descriptive language highlighted by a more extensive supplement that includes an extensive literature review with additional case examples. CONCLUSION: Recommendations are provided to improve consistency both in performing and reporting submandibular gland ultrasound.

Abortion is now illegal in roughly a third of the country, but abortion pills are more widely available than ever before. Clinics, websites, and informal networks facilitate the distribution of abortion pills, legally and illegally, across the United States, while antiabortion advocates and legislators are adopting all manner of strategies to attack pills. This Article is the first in the legal literature to explore this defining aspect of this new environment and the novel issues it raises at the level of state law, federal policy, and on-the-ground advocacy. The Article begins by detailing anti-abortion strategies to stop pills by any means necessary. These tactics include a federal lawsuit attacking the approval and regulation of mifepristone, one of two abortion pills; a revival of the long-unenforced Comstock Act's ban on mailing anything that induces an abortion; a redefinition of abortion's location to chill the provision of medication abortion; attacks on online information and pill supply chains; and attempts to target both those who take abortion pills and those who help others access them. We then consider the opposing movement to increase access to abortion pills: abortion shield laws that protect cross-border telehealth, efforts to evade abortion bans through missed period pills and advance provision, and pharmacist prescribing of abortion pills. Finally, we examine how the U.S. Food and Drug Administration (FDA) can use its powers to increase or decrease access to pills, including lifting the unnecessary restrictions on medication abortion, changing the pills' labels, or asserting that FDA rules governing medication abortion partially preempt state abortion bans. The Article concludes by offering the first analysis of how, after Roe's reversal, abortion pills and their attendant controversies are transforming the abortion debate in this country. With pills, state governments and the medical establishment will lose even more control over abortion; rather, informal and underground networks will meet much of the demand for abortion pills, cutting out gatekeepers. The wide availability of pills will also reshape the definition of abortion--which is ill-suited for the ambiguities of drug provision--and could destigmatize abortion care. At the same time, however, attempts to punish people who provide or use pills will exacerbate the public health and criminal justice consequences that new abortion bans have wrought, entrenching existing class and race disparities. Thus, as abortion pills proliferate--both within and outside of law-abortion inequities could as well. Ultimately, these emerging legal issues will profoundly alter how people think about abortion., Table of Contents Introduction I. The Abortion Pill Revolution II. Policing Pills A. Challenging Mifepristone's FDA Approval and Regulation B. The Comstock Act C. The Location of Abortion D. Information [...]

A single dose of potassium iodide (KI) against a prolonged exposure to repeated radioactivity might not be effective enough to protect the thyroid. Our group have shown that a repetitive dose of KI for eight days offers efficient protection without adverse effects in male rats [1].

The pancreatic islets are composed of discrete hormone-producing cells that orchestrate systemic glucose homeostasis. Here we identify subsets of beta cells using a single-cell transcriptomic approach. One subset of beta cells marked by high CD63 expression is enriched for the expression of mitochondrial metabolism genes and exhibits higher mitochondrial respiration compared with CD63lo beta cells. Human and murine pseudo-islets derived from CD63hi beta cells demonstrate enhanced glucose-stimulated insulin secretion compared with pseudo-islets from CD63lo beta cells. We show that CD63hi beta cells are diminished in mouse models of and in humans with type 2 diabetes. Finally, transplantation of pseudo-islets generated from CD63hi but not CD63lo beta cells into diabetic mice restores glucose homeostasis. These findings suggest that loss of a specific subset of beta cells may lead to diabetes. Strategies to reconstitute or maintain CD63hi beta cells may represent a potential anti-diabetic therapy.

Introduction: Individuals with Autism Spectrum Disorder (ASD) who also exhibit severe to moderate ranges of intellectual disability (ID) still face many challenges (i.e. less evidence-based trials, less inclusion in school with peers).Methods: We implemented a novel model called the Developmental and Sequenced One-to-One Educational Intervention (DS1-EI) in 5-9-year-old children with co-occurring ASD and ID. The treatment protocol was adapted for school implementation by designing it using an educational agenda. The intervention was based on intensity, regular assessments, updating objectives, encouraging spontaneous communication, promoting skills through play with peers, supporting positive behaviours, providing supervision, capitalizing on teachers’ unique skills, and providing developmental and sequenced learning. Developmental learning implies that the focus of training is what is close to the developmental expectations given a child’s development in a specific domain. Sequenced learning means that the teacher changes the learning activities every 10-15 minutes to maintain the child’s attention in the context of an anticipated time agenda.We selected 11 French institutions in which we implemented the model in small classrooms. Each institution recruited participants per dyads matched by age, sex and developmental quotient. Patients from each dyad were then randomized to a DS1-EI group or a Treatment as usual (TAU) group for 36 months. The primary variables – the Childhood Autism Rating scale (CARS) and the psychoeducational profile (PEP-3) – will be blindly assessed by independent raters at the 18-month and 36-month follow-up.Discussion and baseline description: We enrolled 75 participants: 38 were randomized to the DS1-EI and 37 to the TAU groups. At enrolment, we found no significant differences in participants’ characteristics between groups. As expected, exposure to school was the only significant difference (9.4 (±4.1) h/week in the DS1-EI group versus 3.4 (±4.5) h/week in the TAU group, Student’s t-test, t=5.83, p

Bicuspid aortic valve disease (BAVD) is present in up to half of all patients referred for surgical aortic valve replacement (SAVR) yet was an exclusion criterion for all randomized controlled trials (RCTs) comparing transcatheter aortic valve replacement (TAVR) to SAVR. Nonetheless, approximately 10% of patients currently treated with TAVR have BAVD and available observational data for performing TAVR in these patients are limited by selection bias. Many in the cardiovascular community have advocated for RCTs in this population, but none have been performed. The Heart Valve Collaboratory (HVC) is a multidisciplinary community of stakeholders with the aim of creating significant advances in valvular heart disease by stimulating clinical research, engaging in educational activities, and advancing regulatory science. In December 2020, the HVC hosted a Global Multidisciplinary workshop involving over 100 international experts in the field. Following this 2-day symposium, working groups with varied expertise were convened to discuss BAVD, including the need for and design of RCTs. This review, conducted under the auspices of the HVC, summarizes available data and knowledge gaps regarding procedural therapy for BAVD, outlining specific challenges for trials in this population. We also propose several potential studies that could be performed and discuss respective strengths and weaknesses of each approach. Finally, we present a roadmap for future directions in clinical research in TAVR for BAVD with an emphasis both on RCTs and also prospective registries focused on disease phenotyping to develop parameters and risk scores that could ultimately be applied to patients to inform clinical decision-making.

BACKGROUND: Anemia is associated with increased mortality in patients undergoing transcatheter aortic valve replacement (TAVR); however, data on the effect of the severity of and recovery from anemia on clinical outcomes are limited. This study examined the impact of the severity of and recovery from anemia after TAVR. METHODS: Patients with symptomatic, severe aortic stenosis across all surgical risk groups from the Placement of Aortic Transcatheter Valves (PARTNER) I, II, and III trials and registries who underwent TAVR were analyzed. Baseline anemia was defined as mild (hemoglobin [Hb] level ≥11.0 g/dL and

Background Persistence to P2Y12 inhibitors after myocardial infarction (MI) remains low. Out-of-pocket cost is cited as a factor affecting medication compliance. We examined whether a copayment intervention affected 1-year persistence to P2Y12 inhibitors and clinical outcomes. Methods and Results In an analysis of ARTEMIS (Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study), patients with MI discharged on a P2Y12 inhibitor were stratified by baseline out-of-pocket medication burden: low ($0-$49 per month), intermediate ($50-$149 per month), and high (≥$150 per month). The impact of the voucher intervention on 1-year P2Y12 inhibitor persistence was examined using a logistic regression model with generalized estimating equations. We assessed the rates of major adverse cardiovascular events among the groups using a Kaplan-Meier estimator. Among 7351 MI-treated patients at 282 hospitals, 54.2% patients were in the low copay group, 32.0% in the middle copay group, and 13.8% in the high copay group. Patients in higher copay groups were more likely to have a history of prior MI, heart failure, and diabetes compared with the low copay group (all P