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Alternative alignment concepts have garnered great interest in an effort to improve patient satisfaction following primary total knee arthroplasty (TKA). The purpose of this study is to determine variation or deviation from an individual's native joint line in primary TKA using neutral mechanical versus a restricted kinematic technique.An institutional review board-approved prospective cohort study was performed evaluating the effect of neutral mechanical alignment (nMA) versus a restricted kinematic alignment (rKA) on the native joint line in 100 consecutive patients undergoing primary TKA. Using preoperative computed tomography and intraoperative 3-dimensional software, 2 virtual preoperative plans were created: nMA and rKA. Templated bone resections were recorded. Change in joint line was calculated using known implant planar thickness and planned bone resection.nMA yielded significantly greater deviation from the patient's native joint line along the lateral compartment of the knee (lateral distal femoral condyle, lateral posterior femoral condyle, lateral tibial resection). With nMA, the lateral distal femoral joint line was distalized by a mean 4.3 versus 2.6 mm using rKA technique (P.001). In rKA,60% of knees had3 mm of deviation from the native lateral posterior femoral offset, whereas in nMA,95% of knees had ≥3 mm change in the lateral posterior femoral condylar offset.nMA-TKA resulted in statistically larger joint line deviations compared to rKA-TKA, most notably along the lateral distal femoral condyle joint line. Further analysis is needed to determine the clinical consequences of joint line deviation from the native anatomy using nMA as the target for primary TKA.

Tuberculosis (TB) remains one of the most serious diseases caused by a single organism. Multiple (MDR) and extensively (XDR) drug resistant disease poses a threat to global health and requires new drugs and/or innovative approaches to treatment. A number of drugs have been proposed as inhaled therapy for TB, frequently prepared by spray drying. CPZEN-45 is a novel anti-tubercular drug that has poor oral bioavailability but has shown promise when administered via inhalation.Excipient-free CPZEN-45 HCl has been spray dried into a powder with physicochemical characteristics, aerodynamic particle size distribution, and delivered dose suitable for consideration as an inhaled product.The mass median aerodynamic diameter (MMAD) and geometric standard deviation (GSD) of the powder delivered using a RS01 inhaler were 2.62 ± 0.04 μm and 1.76 ± 0.09, respectively. Additionally, the powder was physically and chemically stable after storage at ambient conditions for1.5 years with particle size similar to freshly manufactured product. Overages in spray dried powder were recycled the powder and resprayed into drug product likewise resulting in negligible change in quality thus allowing for further preclinical characterization as necessary. CPZEN-45 was scaled up using pilot-scale manufacturing equipment where the density of the powder was increased to facilitate larger delivered doses without affecting the aerodynamic performance properties.The spray dried powders were suitable for pharmacokinetics, efficacy and preclinical toxicology studies. The final method of manufacture may be used directly for CGMP particle manufacture to support IND and Phase I clinical trials and beyond.

PURPOSE: Many individuals with behavioral health challenges receive services in primary care, and integrated behavioral health (IBH) programs can help increase access to evidence-based interventions. IBH programs can benefit substantially from integrating standardized tracking databases that allow for the implementation of measurement-based care to evaluate patient-, clinician-, and practice-level outcomes. We describe the development and integration of Mayo Clinic’s pediatric and adult primary care psychotherapy tracking database. METHODS: IBH practice leaders directed the development of a large psychotherapy tracking database that continuously populates from Mayo Clinic’s electronic health record system. The database captures numerous patient variables including demographics, behavioral health and substance use issues, psychotherapy principles used, and self-reported symptoms. We retrieved current data for patients empaneled in Mayo Clinic’s pediatric and adult primary care psychotherapy programs from June 2014 to June 2022. RESULTS: The tracking database contained data for 16,923 adult patients and 6,298 pediatric patients. The mean age of adult patients was 43.2 years (SD 18.3), 88.1% were non-Latine White, and 66.7% identified as female. The mean age of pediatric patients was 11.6 years (SD 4.2), 82.5% were non-Latine White, and 56.9% identified as female. We provide examples of practical applications of the database across clinical, educational, research, and administrative domains. CONCLUSIONS: The development and integration of a psychotherapy tracking database supports clinician communication, examination of patient outcomes, practice quality improvement efforts, and clinically relevant research. Our description of Mayo Clinic’s IBH database may serve as a model for other IBH practices.

Background: To examine clinician perspectives on the acceptability, appropriateness/suitability, and feasibility of video telehealth as a way to deliver mental health services during the COVID-19 pandemic. Materials and Methods: Mental health clinicians were surveyed with 27 Likert questions, using previously validated measures, on satisfaction and implementation experience with video telehealth visits between March and June 2020. Results: A total of 112 of 193 clinicians completed the survey (58.0%), including psychiatrists, psychologists, trainees (i.e., residents and fellows), advanced practice providers, and licensed mental health counselors. Clinicians reported high levels of acceptability, feasibility, and appropriateness of video telehealth; they also reported high levels of satisfaction with video telehealth visits. Seventy-nine and a half (79.5%) reported that their patients seemed highly satisfied with video telehealth visits, and 107 (95.5%) of clinicians responded that they would like video telehealth visits to represent at least 25% of their practice in the future. Discussion: Mental health clinicians showed positive attitudes toward the implementation of video telehealth visits, high levels of satisfaction with this care, and indicated strong interest in continuing this modality as a significant portion of clinical practice. Conclusion: This study demonstrates the ability of mental health clinicians to embrace new technology to expand access to care during the COVID-19 pandemic. Results indicate that telemental health is likely to be an integral part of clinic practice in the future.

Background Based on interim analyses and modeling data, lower doses of bamlanivimab and etesevimab together (700/1400 mg) were investigated to determine optimal dose and expand availability of treatment. Methods This Phase 3 portion of the BLAZE-1 trial characterized the effect of bamlanivimab with etesevimab on overall patient clinical status and virologic outcomes in ambulatory patients ≥12 years old, with mild-to-moderate coronavirus disease 2019 (COVID-19), and ≥1 risk factor for progressing to severe COVID-19 and/or hospitalization. Bamlanivimab and etesevimab together (700/1400 mg) or placebo were infused intravenously within 3 days of patients’ first positive COVID-19 test. Results In total, 769 patients were infused (median age [range]; 56.0 years [12, 93], 30.3% of patients ≥65 years of age and median duration of symptoms; 4 days). By day 29, 4/511 patients (0.8%) in the antibody treatment group had a COVID-19-related hospitalization or any-cause death, as compared with 15/258 patients (5.8%) in the placebo group (Δ[95% confidence interval {CI}] = −5.0 [−8.0, −2.1], P Conclusions These data support the use of bamlanivimab and etesevimab (700/1400 mg) for ambulatory patients at high risk for severe COVID-19. Evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants will require continued monitoring to determine the applicability of this treatment. Clinical Trials Registration NCT04427501.

Background: To describe the process of developing an evolving database for Mayo Clinic primary care patients who screen positive for depression. The databases will support a broad use of these data for current and future quality improvement and research efforts. The description of their development will serve as an example for other institutions attempting to create similar data resources. Methods: The adult database (patients aged ³ 18) has data from 2007 and the adolescent database (patients aged 12 to < 18) from 2011. To be included, a patient had to be eligible for collaborative care model as a primary care patient with at least moderate symptoms of unipolar depression. The patient did not have to be enrolled in collaborative care model. The main domains of measurement are demographics, social determinants of health, mental health and substance abuse conditions, other comorbidities, interaction with collaborative care model, and questionnaire results. The data is being continuously updated as new data becomes available. Results: The adult database currently includes 117,619 unique patients with a mean age of 44.7 years, and is 66.4% female, and 88.1% non-Hispanic white. The adolescent database includes 14,684 unique patients with a mean age of 14.8 years, is 66.7% female, and 79.7% non-Hispanic white. Conclusions: These large, longitudinal, and evolving databases are a key step towards developing a learning environment to improve quality of care and conduct population-based research for patients with depression in primary care settings.

Efforts are underway to leverage the expertise of the limited psychiatric workforce by utilizing psychiatrists as consultants to primary care providers (PCPs). These approaches have demonstrated the potential to increase access to care by having PCPs manage patients with common, less complex behavioral health conditions earlier and more effectively, thereby reducing demand for specialty psychiatric evaluation. Multiple approaches to indirect psychiatric consultation have been developed with varying levels of evidence and success. These ongoing efforts will require modifications in workforce training to prepare psychiatrists and PCPs for this new role and in reimbursement approaches that cover the cost of the psychiatric consultants' work.

After fluid administration for vasodilatory shock, vasopressors are commonly infused. Causes of vasodilatory shock include septic shock, post-cardiovascular surgery, post-acute myocardial infarction, postsurgery, other causes of an intense systemic inflammatory response, and drug -associated anaphylaxis. Therapeutic vasopressors are hormones that activate receptors—adrenergic: α1, α2, β1, β2; angiotensin II: AG1, AG2; vasopressin: AVPR1a, AVPR1B, AVPR2; dopamine: DA1, DA2. Vasopressor choice and dose vary widely because of patient and physician practice heterogeneity. Vasopressor adverse effects are excessive vasoconstriction causing organ ischemia/infarction, hyperglycemia, hyperlactatemia, tachycardia, and tachyarrhythmias. To date, no randomized controlled trial (RCT) of vasopressors has shown a decreased 28-day mortality rate. There is a need for evidence regarding alternative vasopressors as first-line vasopressors. We emphasize that vasopressors should be administered simultaneously with fluid replacement to prevent and decrease duration of hypotension in shock with vasodilation. Norepinephrine is the first-choice vasopressor in septic and vasodilatory shock. Interventions that decrease norepinephrine dose (vasopressin, angiotensin II) have not decreased 28-day mortality significantly. In patients not responsive to norepinephrine, vasopressin or epinephrine may be added. Angiotensin II may be useful for rapid resuscitation of profoundly hypotensive patients. Inotropic agent(s) (e.g., dobutamine) may be needed if vasopressors decrease ventricular contractility. Dopamine has fallen to almost no-use recommendation because of adverse effects; angiotensin II is available clinically; there are potent vasopressors with scant literature (e.g., methylene blue); and the novel V1a agonist selepressin missed on its pivotal RCT primary outcome. In pediatric septic shock, vasopressors, epinephrine, and norepinephrine are recommended equally because there is no clear evidence that supports the use of one vasoactive agent. Dopamine is recommended when epinephrine or norepinephrine is not available. New strategies include perhaps patients will be started on several vasopressors with complementary mechanisms of action, patients may be selected for particular vasopressors according to predictive biomarkers, and novel vasopressors may emerge with fewer adverse effects.

Integrating behavioral health into primary care has shown promise in extending access to evidence-based care to the underserved while demonstrating increasing benefits in outcomes and in the practice environment as the level of integration increases. Primary care trainees must be ready for the increase in mental health and substance abuse treatment needs during and after the COVID-19 pandemic. To maximize primary care trainee skill building and leverage adult learning theories, training programs should involve something like apprenticeship rather than being didactic. In fully integrated behavioral health primary care settings, there should be behavioral health resources either on site or available virtually to meet patients' multiple biopsychosocial needs and to support primary care trainees. The level of integration of these programs can be evaluated via the Integrated Practice Assessment tool (IPAT) to assess gaps in structural components and to identify needed resources for fully integrated care settings that provide the optimal training environment. Future assessment of integrated care training is discussed.

The coronavirus pandemic quickly exposed the need for efficient and widespread implementation of telehealth services. Additionally, it further unveiled the impact of social and environmental barriers to healthcare in underserved, rural populations. This in-practice pilot study tested the utility of a geographically centralized social worker providing services between a patient and a primary care provider via telecommunication at two high volume rural outpatient family practice clinics. Outcome measures included patient and provider satisfaction. Twenty-two telehealth social work encounters occurred spanning both adult and pediatric patients. Data collected from patients, primary care providers, and social work staff revealed positive feedback. The data from our small pilot study demonstrated that social work triage delivered via a tablet was an acceptable and valued resource in busy primary care practices.

The purpose of this study was to determine if significant clinical differences exist in patient-reported outcome measures (PROMs) between PS and CR TKAs implanted using robotic-assisted technology. This was an IRB-approved retrospective study from an institutional database evaluating 214 knees in 190 patients. Inclusion criteria included: primary RA-TKA, age 22-89 at the time of surgery, preoperative coronal limb deformity within 15º of neutral alignment, and minimum 1-year follow-up. The PS cohort consisted of 103 patients with 107 RA-TKAs, whereas the CR cohort consisted of 87 patients with 107 RA-TKAs. Cohorts were compared on the basis of demographics and PROMs (KSS knee, KSS function, FJS-12, KOOS-JR, WOMAC, and 5-point satisfaction Likert scale) collected preoperatively and at 1-year follow-up. Statistical analyses comparing measures were conducted via Student's t tests for continuous data and Chi-squared analyses for categorical data. There were no significant differences identified in short-term PROMs at 1-year follow-up between cohorts (all p values 0.05). 93.1% of patients with CR knees and 94.7% of patients with PS knees reported a satisfaction level of "very satisfied" or "satisfied". Revision arthroplasty occurred in six knees (2.8%, 3 knees in CR cohort, 3 knees in PS cohort) with no differences in overall complications between groups. The use of RA-TKA technology promoted high patient satisfaction scores within this study, independent of CR or PS implant type with no significant differences in PROMs, satisfaction, revisions, or complications between the two groups.

Integrated behavioral health is a population-based approach that acknowledges the chronic nature of most mental illnesses and the need for services beyond those delivered in face-to-face visits. These services have been referred to by different and confusing names with over 40 definitions of care coordination concepts in the literature. Kilbourne et al. in a recent article in this journal divided these tasks into three groups: care coordination, care management and case management with associated definitions provided as used in the veterans affairs system. In this commentary, while drawing on over a decade of experience in implementing care management models in the Mayo clinic system of care, I will suggest we need to be even more specific with these definitions. I propose these terms be linked to critical and measurable tasks in the management of chronic conditions, thus allowing those administrating or researching these interventions to better assess fidelity, processes and outcomes when a model is applied to a population of patients with chronic conditions in an integrated setting.

Background Care coordination has been a common tool for practices seeking to manage complex patients, yet there remains confusion about the most effective and sustainable model. Research exists on opinions of providers of care coordination but there is limited information on perspectives of those in the insurance industry about key elements. We sought to gather opinions from primary care providers and administrators in Minnesota who were involved in a CMS (Center for Medicare and Medicaid Services) transformational grant implementing COMPASS (Care Of Mental, Physical And Substance-use Syndromes), an evidence-based model of care coordination for depressed patients comorbid with diabetes and/or cardiovascular disease. We then sought to compare these views with those of private insurance representatives in Minnesota. Methods We used qualitative methods to conducted forty-two key informant interviews with primary care providers (n = 15); administrators (n = 15); and insurers (n = 12). We analyzed the recorded and transcribed data, once de-identified, using a frameworks analysis approach. Results We identified six primary themes: 1) a defined scope, rationale, and key partnerships for building comprehensive care coordination programs, 2) effective information exchange, 3) a trained and available workforce, 4) the need for a business model and a financially justifiable program, 5) a need for evaluation and ongoing improvement of care coordination, and 6) the importance of patient and family engagement. Overall consensus across stakeholder groups was high including a call for payment reform to support a valued service. Despite their role in paying for care, insurance representatives did not stress reduced utilization as more important than other outcomes. Conclusions Primary care providers and administrators from different organizations and backgrounds, all with experience in COMPASS, in large part agreed with insurance representatives on the main elements of a sustainable model and the need for health reform to sustain this service. Electronic supplementary material The online version of this article (10.1186/s12913-019-3916-5) contains supplementary material, which is available to authorized users.

Introduction Lower socioeconomic status (SES) has been associated with poor healthcare outcomes in depression. However, reliable individual-level SES data rarely exists for clinical research. The HOUSES index relies on publicly available data allowing for evaluation of individual-level SES on patient outcomes. Hypothesis Primary care patients with depression within the lower SES quartile (Quartile 1 vs. Quartile 4, of the HOUSES index) would experience worse clinical outcomes of their symptoms six months after diagnosis. Study design A retrospective cohort study which followed 4313 adult primary care patients that were diagnosed with depression during the study period of 2008–2015. The outcome measures were the six month PHQ-9 scores. Results At six months, a higher HOUSES quartile was associated with greater odds of remission of depressive symptoms (RDS) and lower odds of persistent depressive symptoms (PDS), after controlling for covariates. Patients in Quartile 4 had 27% more likelihood of RDS and a 24% lower likelihood of PDS at six months compared to a Quartile 1 patient. Limitations As a retrospective study only can observe associations but not causation. Only one institution participated and not all treatments were readily available, limiting the generalizability of these findings. Conclusions Lower SES as demonstrated by a lower HOUSES quartile (Quartile 1 versus 4) was associated with lower odds of RDS and increased odds of PDS at six months. HOUSES index is a useful tool for identifying patients at risk for worse clinical outcomes and may help health care systems plan resource allocation for depression care.

Pulmonary neuroendocrine tumors (NETs) are a group of rare tumors that pose a high financial burden on patients and the United States healthcare system. The usual presenting symptoms include cough or wheezing, hemoptysis, or chest pain. Due to bronchial obstruction, patients may also present with recurrent pneumonia. Acute pancreatitis has yet to be documented as the initial manifestation of this disease. Atypical carcinoids - a subtype of NETs - are heterogeneous regarding their site of origin, biological behavior, and malignant potential. Studies show that the most common primary tumor site varies by race, with the lung being the most common in white patients and the rectum being the most common in Asian/Pacific Islander, American Indian/Alaskan Native, and African American patients. Certain carcinoid tumors, such as those of the rectum, are over-represented among the Black and Asian populations within the United States, suggesting the role of genetics in the development of this intriguing disease. Furthermore, the pancreas is not a usual site of metastasis for primary lung NET. Our case study describes the rare occurrence of a primary pulmonary NET (atypical carcinoid) metastasizing to the pancreas and presenting as acute pancreatitis.

Purpose of Review This review discusses the role of the patient-centered medical home (PCMH) in treating depression, focusing on findings from primary care-based studies and their implications for the PCMH. Recent Findings Pharmacotherapy, psychotherapy, and collaborative care are evidence-based treatments for depression that can be delivered in primary care and extended to diverse populations. Recent research aligns with the core components of the PCMH model. Summary The core components of the PCMH are critical elements of depression treatment. Comprehensive care within the PCMH addresses medical and behavioral health concerns, including depression. Psychiatric and psychological care must be flexibly delivered so services remain accessible yet patient-centered. To ensure the quality and safety of treatment, depression symptoms must be consistently monitored. Coordination within and occasionally outside of the PCMH is needed to ensure patients receive the appropriate level of care. More research is needed to empirically evaluate depression treatment within the PCMH.

Marine plastic is a major worldwide challenge, for which many solutions are being proposed. However, most of the solutions focus on the prevention and collection of the plastic, with little emphasis on the development of waste treatment options. This review seeks to propose areas where further studies could assist to close gaps in knowledge. Some identified gaps include a poor understanding of the quantities and composition of marine plastics, a lack of information about existing marine plastic treatment technologies, and the environmental impact of the available options. To better understand the capabilities of the current South African plastics recycling industry, data from the South African Waste Information Centre (SAWIC) are reported and discussed. While there is a lack of technology development for the treatment of marine plastic globally, the intention of this review is to drive research in this area by creating awareness and encouraging implementation of possible treatment technologies.

BACKGROUND Patient-centered registries are essential in population-based clinical care for patient identification and monitoring of outcomes. Although registry data may be used in real time for patient care, the same data may further be used for secondary analysis to assess disease burden, evaluation of disease management and health care services, and research. The design of a registry has major implications for the ability to effectively use these clinical data in research. OBJECTIVE This study aims to develop a systematic framework to address the data and methodological issues involved in analyzing data in clinically designed patient-centered registries. METHODS The systematic framework was composed of 3 major components: visualizing the multifaceted and heterogeneous patient-centered registries using a data flow diagram, assessing and managing data quality issues, and identifying patient cohorts for addressing specific research questions. RESULTS Using a clinical registry designed as a part of a collaborative care program for adults with depression at Mayo Clinic, we were able to demonstrate the impact of the proposed framework on data integrity. By following the data cleaning and refining procedures of the framework, we were able to generate high-quality data that were available for research questions about the coordination and management of depression in a primary care setting. We describe the steps involved in converting clinically collected data into a viable research data set using registry cohorts of depressed adults to assess the impact on high-cost service use. CONCLUSIONS The systematic framework discussed in this study sheds light on the existing inconsistency and data quality issues in patient-centered registries. This study provided a step-by-step procedure for addressing these challenges and for generating high-quality data for both quality improvement and research that may enhance care and outcomes for patients. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18366

Background: Collaborative care models have been shown to improve mental and physical health, but their effectiveness varies. Implementation science frameworks identify measures at the structural (eg, sociocultural context, public policies), organizational, provider, innovation, and patient levels that may facilitate or impede collaborative care effectiveness. Objective: To describe commonalities and variation in multilevel measures associated with the implementation of Care of Mental, Physical, and Substance-Use Syndromes (COMPASS), a large-scale collaborative care intervention for depression, diabetes, and cardiovascular disease. Design: Qualitative study using semistructured descriptive data obtained from annual site visit reports and supplemental site surveys. Participants: COMPASS care teams from 8 health care systems serving 3854 patients with active depression and poorly controlled diabetes and/or cardiovascular disease. Intervention: COMPASS included weekly case reviews with a consulting physician and psychiatrist, a patient-tracking registry, and monitoring of hospital and emergency department use. Main Measures: Site visit reports were analyzed with Atlas.ti software to qualitatively describe implementation measures and their variation across sites. Key Results: Nine measures were identified that impacted implementation efforts across health systems: (1) challenges in health systems9 organizational environments, (2) prior care coordination experience, (3) physician engagement, (4) care team trust and cohesion, (5) care manager training and experience, (6) patient enrollment length, attainment of clinical targets, and frequency/content of care manager contacts, (7) patient-tracking registries, (8) quality improvement and outcomes monitoring reports, and (9) patients9 social needs. Conclusions: Understanding multilevel measures impacting COMPASS implementation could increase the success of future collaborative care implementation efforts.

The Group-Contribution with Association equation of state (GCA-EOS) has been applied to represent the phase behaviour of binary systems containing either trifluoromethane (R-23) or hexafluoroethane (R-116) with alkanes. The model was successfully fitted to selected literature data, which also formed part of a study into the use of these refrigerants as supercritical fluid extraction solvents. The tuned model was tested against the available experimental data covering the homologous series of C2 to C11 alkanes with either R-23 or R-116, at temperatures of between (193 and 343) K and at pressures of up to 60 MPa. The tuned model provided accurate predictions of the phase behaviour of these systems, including the ability to identify the carbon number of the alkane in the system at which the phase equilibria transformation occurred. The comparison of the model to the experimental data was excellent, with absolute average relative deviations of between (1 and 5) % for both pressure and vapour phase compositions. Fil: Mark D. Williams-Wynn. University of KwaZulu-Natal; Sudáfrica Fil: Sánchez, Francisco Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Planta Piloto de Ingeniería Química. Universidad Nacional del Sur. Planta Piloto de Ingeniería Química; Argentina Fil: Paramespri Naidoo. University of KwaZulu-Natal; Sudáfrica Fil: Pereda, Selva. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Planta Piloto de Ingeniería Química. Universidad Nacional del Sur. Planta Piloto de Ingeniería Química; Argentina. University of KwaZulu-Natal; Sudáfrica Fil: Deresh Ramjugernath. University of KwaZulu-Natal; Sudáfrica

The isothermal vapour-liquid equilibria of R-23 + 1-hexene, R-23 + 3-methylpentane, R-116 + 1-hexene and R-116 + 3-methylpentane were measured at temperatures of between (293.1 and 313.3) K with a static-analytic apparatus. Vapour-liquid-liquid equilibria was exhibited by the R-116 + 1-hexene system. The equilibrium data was modelled with the PR EOS, modified with the MC alpha function, and the WS mixing rule with either the NRTL or the UNIQUAC activity coefficient model. Both the temperature dependent and the temperature independent forms of the models were regressed to the experimental data. The method of Ungerer et al. was used to extrapolate the subcritical co-existence data to the mixture critical loci, while the method of Heidemann and Khalil was used to estimate the critical locus curves for the systems. Each of the four systems were also categorised according to the classification system of van Konynenburg and Scott.

The isothermal vapour-liquid and vapour-liquid-liquid equilibria of five binary refrigerant + n-alkane systems at near ambient temperatures were measured using a static-analytic apparatus and a static-synthetic apparatus. The phase equilibrium data for the systems of trifluoromethane (R-23) + n-nonane and hexafluoroethane (R-116) + n-decane were measured using the static-analytic apparatus, whereas bubble point data were measured with the static-synthetic apparatus for the systems of R-23 + n-decane, R-23 + n-undecane and R-116 + n-nonane. The temperatures that were investigated for these systems ranged between (272.9 and 323.1) K. The experimental phase equilibrium data were modelled with the PR EOS and the MC alpha function. The WS mixing rule, incorporating either the NRTL or the UNIQUAC activity coefficient model, was used to apply the model to the mixture data. The temperature independent forms of the thermodynamic model were found to provide a more accurate representation of the experimental data than the temperature dependent forms. A single mixture critical point was determined using the indirect extended scaling laws of Ungerer et al. (2005). The calculation procedure of Heidemann and Khalil (1980) was used to estimate segments of the critical locus curves for the binary systems for which data were measured close to the critical locus curve. The van Konynenburg and Scott classification for each system was defined, based upon the characteristics of the critical locus curves within the temperature ranges that were studied.

Purpose/Objective(s) The mortality of the SARS-CoV-2 virus (COVID-19) has been associated with a pulmonary inflammatory response resulting in hypoxemia and rapid clinical decline. Recent work has indicated a potential therapeutic window for treatment to prevent ventilator-dependence thereby reducing mortality. PREVENT is an ongoing prospective multicenter Phase II randomized controlled trial where patients hospitalized with COVID-19 pneumonia are randomized to ultra-low dose radiation therapy (RT) versus control. This study is registered at clinicaltrials.gov, NCT04466683. The following is a description of the inpatient onboarding process of the center contributing the largest number of patients to this trial. Materials/Methods COVID-19 hospital admissions from the previous day were attained by the clinical research manager each morning, screened for eligibility, and then sent to the designated radiation oncologist who further delineated from this list. Common exclusion criteria were: 1. Oxygen saturation > 96% on room air, 2. Age < 50, 3. > 9 days from initial COVID-19 symptomatology. From this list, HIPAA-compliant text message contact was made with infectious disease, critical care, and nursing staff with reciprocal discussion of the trial protocol and approval for consulting the patient. Subsequently, a virtual consult was made with the patient, with witnessed informed consent obtained via telephone and in person by our research associate. Patients randomized to RT were treated within 24 hours of consent. Simulation and treatment were performed on a linear accelerator with one personal protective equipment-protected therapist moving in and out of the treatment room, and a second therapist manning the console. On-site dose calculation was performed by physics, after which the radiation oncologist approved the fields prior to treatment delivery. Simulation and treatment were performed without a computer plan; therapists underwent several practice sessions prior to treating patients on trial. Results Between August 28, 2020 and October 6, 2020, the first 10 enrolled patients on this multicenter trial were randomized and treated at our institution; no research staff member nor radiation oncology clinical team member contracted COVID-19 while employing this protocol. Conclusion This represents the first published protocol to address efficient and safe recruitment of COVID-19 patients for a radiation oncology trial. Despite the procedural hurdles of conducting a trial in the midst of a pandemic, the combination of recruitment efficiency (> 2 patients/week) and safety to the research and clinical teams (no COVID-19 infections) of this protocol has allowed for the PREVENT trial to make substantial progress in meeting recruitment goals (n = 100). This onboarding process serves as a model in conducting recruitment of COVID-19 patients for clinical trials, and is worthy of emulation at additional centers.

Experimental vapor–liquid equilibrium data are reported for the binary systems of perfluorooctane + either oxygen, nitrogen, or methane. Isothermal measurements were performed within the temperature range of 293.21 to 353.23 K, and at pressures up to 21 MPa, using two apparatuses; one based on the “static-analytic” method and the other on the “static-synthetic” method. The experimental data were correlated using the perturbed-chain statistical associating fluid theory equation of state. The model provides a satisfactory representation of the experimental data within the measured temperature range.

Isothermal vapor–liquid equilibrium (VLE) data for the system of hexafluoroethane (R-116) + n-butane are reported in this paper. The measurements were undertaken at six different temperatures ranging from 273.27 to 323.19 K, with pressure ranging from 0.104 to 3.742 MPa. Two of the temperature sets were measured below, and the remaining four were measured above, the critical temperature of R116. The measurements were performed in a “static-analytic” type VLE apparatus. The sampling of the equilibrium phases was performed via pneumatic ROLSI capillary samplers (Armine’s patent). The equipment was developed in the CEP/TEP laboratory at MINES ParisTech. Combined expanded uncertainties in the measurements were estimated to be 0.02 K for temperature, 0.0006 MPa for pressure, and maximum of 0.004 for composition, based on the NIST guidelines. Each set of isothermal vapor–liquid equilibrium data was correlated with the Peng–Robinson equation of state (PR-EOS). The Mathias–Copeman alpha function, and the Wong–San...

Objective The spread of evidence-based care is an important challenge in healthcare. We evaluated spread of an evidence-based large-scale multisite collaborative care model for patients with depression and diabetes and/or cardiovascular disease (COMPASS). Methods Primary care patients with depression and comorbid diabetes or cardiovascular disease were recruited. Collaborative care teams used care management tracking systems and systematic case reviews to track and intensify treatment for patients not improving. Targeted outcomes were depression remission and response (assessed with the Patient Health Questionnaire-9) and control of diabetes (assessed by HbA1c) and blood pressure. Patients and clinicians were surveyed about satisfaction with care. Results Eighteen care systems and 172 clinics enrolled 3609 patients across the US. Of those with uncontrolled disease at enrollment, 40% achieved depression remission or response, 23% glucose control and 58% blood pressure control during a mean follow-up of 11 months. There were large variations in outcomes across medical groups. Patients and clinicians were satisfied with COMPASS care. Conclusions COMPASS was successfully spread across diverse care systems and demonstrated improved outcomes for complex patients with previously uncontrolled chronic disease. Future large-scale implementation projects should create robust processes to identify and reduce expected variation in implementation to consistently provide improved care.

Fil: Gonzalez Prieto, Mariana. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Bahia Blanca. Planta Piloto de Ingenieria Quimica. Universidad Nacional del Sur. Planta Piloto de Ingenieria Quimica; Argentina

Evidence for patient portals on health outcomes is still accumulating.We performed a retrospective study of patients in a depression collaborative care management (CCM) program comparing dropout rates and outcomes at six months in patients who used the portal with their CCM managers versus those who did not use the portal for this purpose.1769 patients were analyzed, of which 272 (15.4%) used the portal to connect with their CCM managers. Portal users were more likely to be younger (mean age 37.8 years versus 42.6 years p0.001), married (57.5% versus 48.2% p=0.003) and female (81% versus 69.4% p0.001) compared to non-portal users. Completion of six month PHQ 9 forms was significantly higher in the portal group (75.7% vs. 65.7%, p=0.001) with an adjusted odds ratio (AOR) of 1.68 (1.25, 2.30, p0.001). Using an intention to treat analysis, remission at 6 months was significantly higher in the portal group (45.2% vs 38.5%, p=0.038) with an AOR of 1.32 (1.00-1.73, p=0.47). However analysis of only those who completed a PHQ-9 at six months showed no difference in depression remission (59.7% vs 58.7%, p=0.78) with an AOR of 1.02 (0.75, 1.42. p=0.87). There was no difference in dropout rates between portal users compared to non-portal users (31.6% vs. 31.7%, p=0.97) with an AOR of 0.95 (0.71, 1.27, p=0.69).Limitations include the observational study design and a predominantly white study population.Use of a patient portal in depression CCM allows additional options for patients to participate without negatively influencing clinical outcomes.

Despite increased attention on prevention and early aggressive treatment with antibiotics and smart fluid resuscitation, there remains high morbidity and mortality from septic shock globally (1). Frequently septic patients develop persistent distributive shock that often requires vasopressor infusion to restore adequate mean arterial pressure (MAP) in order to provide adequate perfusion to critical organs and tissues. Although there are a variety of catecholamines available to increase blood pressure in these critically ill patients, the unmet need for additional therapies remains because of the persistently high morbidity and mortality of septic shock.

Isothermal vapour-liquid equilibrium (VLE) values for two binary systems; trifluoromethane and n-heptane at temperatures between T = (272.9 and 313.2) K, and hexafluoroethane and n-heptane at temperatures between T = (293.0 and 313.2) K were measured with a static-analytic apparatus. Bubble pressures at temperatures between T = (293.0 and 313.2) K, at several compositions, were also measured with a variable-volume static-synthetic apparatus. Vapour-liquid-liquid equilibrium (VLLE) was found to occur for certain isotherms for both of the systems. The PR EOS, with the Mathias-Copeman (MC) alpha function, combined with either the classical mixing rule or the Wong-Sandler (WS) mixing rule was used to correlate the experimental results. Either the NRTL or the UNIQUAC activity coefficient model was used within the WS mixing rule. The indirect extended scaling laws of Ungerer et al. were used to extrapolate critical loci from the experimental coexistence data, and the calculation procedure of Heidemann and Khalil was employed to calculate the mixture critical locus curves at temperatures close to the refrigerant critical temperatures. At lower temperatures on the mixture critical curve, gas-liquid critical points occurred, whereas, at higher temperatures, the critical points occurred along a liquid-liquid locus curve. The two systems were categorised according to the van Konynenburg and Scott classification.

The ability to aggregate clinical data across multiple diverse organizations and to use it for performance measurement, quality improvement, evaluation, and research is rapidly becoming a national necessity, but there are few examples of how to do that. This article uses lessons from a national effort to implement the collaborative care management model for patients with both depression and diabetes or heart disease across 8 partner organizations, 18 medical groups, and more than 170 clinics in 8 states to identify the challenges and provide experience-based recommendations for those tasks. The challenges are divided into those needed for (1) collecting similar data, (2) aggregating those data across care systems, and (3) using the data to both improve and evaluate care. Start with agreement on goals, methods, transparency, and a data system integrated into the electronic medical record while promptly addressing all the legal, regulatory, and human subject requirements.

Few studies have evaluated exercise interventions for smokers with depression or other psychiatric comorbidities. This pilot study evaluated the potential role of supervised vigorous exercise as a smoking cessation intervention for depressed females. Thirty adult women with moderate-severe depressive symptoms were enrolled and randomly assigned to 12 weeks of thrice weekly, in person sessions of vigorous intensity supervised exercise at a YMCA setting (EX; n = 15) or health education (HE; n = 15). All participants received behavioral smoking cessation counseling and nicotine patch therapy. Assessments were done in person at baseline, at the end of 12 weeks of treatment, and at 6 months post-target quit date. Primary end points were exercise adherence (proportion of 36 sessions attended) and biochemically confirmed 7-day point prevalence abstinence at Week 12. Biomarkers of inflammation were explored for differences between treatment groups and between women who smoked and those abstinent at Week 12. Treatment adherence was high for both groups (72% for EX and 66% for HE; p = .55). The Week 12 smoking abstinence rate was higher for EX than HE (11/15 [73%] vs. 5/15 [33%]; p = .028), but no significant differences emerged at 6-month follow-up. Interleukin-6 levels increased more for those smoking than women abstinent at Week 12 (p = .040). Vigorous intensity supervised exercise is feasible and enhances short-term smoking cessation among depressed female smokers. Innovative and cost-effective strategies to bolster long-term exercise adherence and smoking cessation need evaluation in this population. Inflammatory biomarkers could be examined in future research as mediators of treatment efficacy. This preliminary study found that vigorous intensity supervised exercise is feasible and enhances short-term smoking cessation among depressed female smokers. This research addressed an important gap in the field. Despite decades of research examining exercise interventions for smoking cessation, few studies were done among depressed smokers or those with comorbid psychiatric disorders. A novel finding was increases in levels of a pro-inflammatory biomarker observed among women who smoked at the end of the intervention compared to those who did not.

As part of the FutureGen 2.0 Project, a design was developed for a first-of-its-kind, commercial-scale, near-zero emissions coal-fueled power plant that includes carbon capture and storage (CCS) in a deep saline reservoir. To assess storage site performance and meet the regulatory requirements of the Class VI Underground Injection Control Program for CO2 Geologic Sequestration, the FutureGen 2.0 Project evaluated, selected, and designed a suite of monitoring technologies for use in (1) evaluating CO2 mass balance, (2) detecting significant loss of CO2 containment, (3) tracking the spatial extent of the CO2 plume and advancement of the pressure front within the storage reservoir, and (4) identifying the occurrence and location of injection-related induced seismicity. The monitoring program design includes direct monitoring of the injection process (above ground and in the injection wells), injection-zone monitoring, early-leak-detection monitoring directly above the primary confining zone, and compliance monitoring within the lowermost underground source of drinking water (USDW); it also includes measurements of formation pressure and other geochemical/isotopic signatures that provide an indication of changes in CO2 concentration and/or brine composition, both within the injection zone and immediately above the primary confining zone. In addition to these direct measurements, several indirect geophysical monitoring technologies were included in the monitoring program design such as passive seismic and integrated surface deformation monitoring. Although the FutureGen 2.0 Project was suspended by the U.S. Department of Energy prior to implementation of the monitoring program design, this overview is provided with the hope that other current or future CCS projects will derive benefit from consideration of the approach and monitoring network configuration adopted by the project.

Laboratory experiments were conducted to evaluate the impact of supercritical carbon dioxide (scCO2) injection on aqueous and solid phase geochemistry, and subsequent changes in permeability. These experiments showed that brine displacement from the Mount Simon Sandstone cores (∼1200 m depth) by scCO2 was inefficient by advection, because the low viscosity scCO2 flows predominantly in larger pores, leaving a significant amount of brine in smaller pores. Acidification caused by scCO2 injection resulted in significant increases in Mg2+, K+, Na+, SO42− Al3+, and silica concentrations are likely from differing rates of carbonate, clay, albite, and K-feldspar dissolution. The mass of precipitates that formed over 1.2 years (NaCl, KCl, lead oxide, and forsterite) was small, as observed by electron microprobe analysis and did not influence permeability. Trace metals that increased during scCO2 injection included Ba, Mn, Sr, Ni, Sn, Bi, Cu, Li, P, and Zn, and trace metals that decreased included Hg, Pb, and Co. The scCO2 injection experiments also showed a moderate amount of particulate (iron oxide) movement correlated with the fraction of scCO2, but the sandstone permeability did not change, even after substantial (i.e., 115 pore volumes) scCO2 injection. Anaerobic and aerobic microbial growth was observed (23 and 14 times, respectively) correlated with higher scCO2 concentration, but the calculated change in pore space occupied by the increase in biomass is insignificant. The small observed geochemical and microbial changes are not expected to reduce the ability to inject scCO2 into the reservoir, but significant increases in trace metal concentrations could magnify the water quality impact of a potential leak of reservoir fluids into an overlying aquifer.