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Intraoperative language and sensorimotor function mapping with direct electrical stimulation allows precise identification of functionally important brain regions. Direct electrical stimulation brain mapping has become the standard of care for the resection of brain lesions near or within eloquent regions with various patient outcome benefits. Intraoperative stimulation mapping (ISM) is commonly performed in an awake patient for language and motor assessments. However, motor mapping under general anesthesia, termed asleep motor mapping, has been increasingly performed over the last two decades for lesions primarily affecting the motor areas of the brain. Both asleep-awake-asleep and monitored anesthesia care have been successfully used for awake craniotomy in modern neuroanesthesia. Each anesthetic agent exerts varying effects on the quality of ISM, especially under general anesthesia. Careful selection of an anesthetic technique is crucial for the successful performance of ISM in both awake and asleep conditions. A comprehensive search was performed on electronic databases such as PubMed, Embase, Cochrane, Scopus, Web of Science, and Google Scholar to identify articles describing anesthesia for awake craniotomy, intraoperative brain mapping, and asleep motor mapping. In the second part of this narrative review, we summarize the effects of different anesthetic regimes and agents on ISM, causes of the failure of awake craniotomy and mapping, and outline the anesthetic considerations for ISM during awake craniotomy and asleep motor mapping.

Brain mapping has evolved tremendously in the past decade, fueled by advances in functional neuroimaging technology in neuro-oncology and epilepsy surgery. Despite this, wide anatomic-functional interindividual variability and intraoperative brain shift continue to challenge neurosurgeons performing surgery within or near eloquent brain regions. As such, intraoperative direct cortical and subcortical stimulation mapping remains the gold standard for localizing eloquent brain regions with precision for a safe and tailored resection. Intraoperative stimulation mapping (ISM) allows for maximizing the extent of resection while minimizing postoperative neurological deficits, resulting in better patient outcomes. Understanding the technical nuances of ISM is imperative for the anesthesiologist to provide better anesthetic management tailored to the surgery and stimulation mapping planned. A comprehensive search was performed on electronic databases to identify articles describing intraoperative cortical and subcortical mapping, language, and motor mapping. In the first part of this narrative review, we summarize the salient technical aspects of ISM and the common neurophysiological tasks assessed intraoperatively relevant to the anesthesiologist.

Abstract With the recent increase in RNA sequencing efforts using large cohorts of individuals, surveying allele-specific gene expression is becoming increasingly frequent. Here, we report that, despite not containing explicit variant information, a list of genes known to be allele-specific in an individual is enough to recover key variants and link the individuals back to their genotypes and phenotypes. This creates a privacy conundrum.

Abstract Background We aimed to investigate the effects of COVID‐19 on computed tomography (CT) imaging of cancer. Methods Cancer‐related CTs performed at one academic hospital and three affiliated community hospitals in Massachusetts were retrospectively analyzed. Three periods of 2020 were considered as follows: pre‐COVID‐19 (1/5/20–3/14/20), COVID‐19 peak (3/15/20–5/2/20), and post‐COVID‐19 peak (5/3/20–11/14/20). 15 March 2020 was the day a state of emergency was declared in MA; 3 May 2020 was the day our hospitals resumed to non‐urgent imaging. The volumes were assessed by (1) Imaging indication: cancer screening, initial workup, active cancer, and surveillance; (2) Care setting: outpatient and inpatient, ED; (3) Hospital type: quaternary academic center (QAC), university‐affiliated community hospital (UACH), and sole community hospitals (SCHs). Results During the COVID‐19 peak, a significant drop in CT volumes was observed (−42.2%, p

Background: The use of intraoperative neuromonitoring is a well-established method of detecting neurologic injuries during spine surgery. Anaesthesia, especially inhalational agents, influence motor evoked potential (MEP) monitoring. The aim of our study was to compare the effect of balanced anaesthesia (BA) (intravenous plus inhalational anaesthesia) and total intravenous anaesthesia (TIVA) on the incidence of intraoperative neuromonitoring changes, interventions performed and neurological outcomes of patients following high-risk spinal surgery. Methods: After Research and Ethics Board approval, a retrospective review of 155 patients who underwent spinal surgery with MEP was performed. Data were collected on changes in MEP and/or somatosensory evoked potential, interventions performed and neurological outcomes. Patients were divided into BA and TIVA groups and data were analysed. Results: A total of 152 patients were eligible for the study (mean age 54 ± 17, male: female 45:55). A BA technique was used in 62% and TIVA in 38%. Desflurane (

Background: The basic training for ASHA workers in Tamil Nadu include a module on Non-Communicable diseases with inadequate focus on Mental Health. As a part of the Community Based Assessment Checklist, ASHAs are trained in administration of Patient Health Questionnaire-2 to screen for depression. However, there is significant gap in the primary prevention of depression in the communities in terms of screening, basic counselling services and knowledge and attitude among community health workers Objective: This study aimed to assess the feasibility of capacity building of Community Health Workers in screening for depression and suicide risk and provision of Psychological First Aid Services Methodology: 117 Community Health Workers including ASHAs, AWWs, ANMs, WHVs, VHNs and UHNs were trained in WHO Psychological First Aid, PHQ-9 administration and WHO MhGAP 10 questions on suicide risk screening in Thiruvannamalai, Vellore and Tiruvallur District of Tamil Nadu Results: Of the 1371 individuals screened, 13.18% were positive for depression and 38% were positive for atleast one suicide risk. The most common suicide risk observed was chronic pain followed by extreme hopelessness. PHQ-9 and Suicide risk assessment was easy to administer among ANM, VHN and UHNs. However, ASHAs and Women Health Volunteers reported that PHQ-2/WHO Wellbeing Index was an easier tool to use in the field. Psychological First Aid training can be easily delivered by non-medical professionals to health workers. Conclusion: Community Health Workers can provide primary prevention in mental health by provision of Psychological First Aid to their community. Depression screening should be simplified by PHQ-2/WHO Well being index

Background: Prior studies suggest similar long-term mortality rates for patients with heart failure (HF) with preserved ejection fraction (HFpEF) vs reduced ejection fraction. However, although coronary heart disease (CHD) is associated with worse prognosis in HF, clinical outcomes are less well characterized for HF without CHD. We investigated the characteristics and 5-year mortality outcomes among patients with HF without significant CHD, stratified by EF. Methods: Patients with clinical heart failure who underwent coronary angiography at Duke University Medical Center from 1996 through 2009 and had no significant CHD with EF ≤ 40% were compared with patients without significant CHD with EF > 40%. Survival was examined using Kaplan-Meier methods and multivariable Cox proportional hazards modeling. Analyses were repeated using EF ≥ 50%. Results: Of 3154 patients with HF without significant CHD, 1530 (48.5%) had HFpEF (EF > 40%). These patients were older and more likely to have a Charlson Index ≥ 2 than patients with reduced EF. Patients with HFpEF had a lower risk of death than those with reduced EF (unadjusted hazard ratio [HR] 0.85; 95% confidence interval [CI] 0.74-0.99). From 1996 through 2009, the secular trend of death decreased among patients without CHD and with reduced EF (HR 0.92; 95% CI 0.88-0.97) but not among those with preserved EF (HR 0.99; 95% CI 0.93-1.05; P interaction 0.095). No finding was significant after multivariable risk adjustment. Results were consistent when defining preserved EF as EF ≥ 50%. Conclusions: Among patients without significant CHD, those with HFpEF had similar risks of 5-year mortality as patients with HF with reduced ejection fraction. Résumé: Introduction: Des études antérieures indiquent des taux de mortalité à long terme similaires entre les patients atteints d’insuffisance cardiaque (IC) avec fraction d’éjection (FE) préservée (ICFEP) vs les patients atteints d’IC avec FE réduite (ICFER). Toutefois, bien que la coronaropathie soit associée à un plus mauvais pronostic de l’IC, les résultats cliniques sont moins bien définis que ceux de l’IC sans coronaropathie. Nous avons examiné les caractéristiques et les résultats des patients atteints d’IC sans coronaropathie importante, stratifiés selon la FE, sur la mortalité dans les cinq ans. Méthodes: Nous avons comparé les patients montrant des signes cliniques d’IC qui avaient subi une angiographie coronarienne à la Duke University de 1996 à 2009 et n’avait pas de coronaropathie importante avec FE ≤ 40 % aux patients sans coronaropathie importante avec FE > 40 %. Nous avons examiné la survie à l’aide de la méthode de Kaplan-Meier et du modèle multivarié à risques proportionnels de Cox. Nous avons répété les analyses en fonction d’une FE ≥ 50 %. Résultats: Parmi les 3 154 patients atteints d’IC sans coronaropathie importante, 1 530 (48,5 %) avaient une ICFEP (FE > 40 %). Ces patients étaient plus âgés et plus susceptibles d’avoir un indice de Charlson ≥ 2 que les patients atteints d’ICFER. Les patients atteints d’ICFEP avaient un risque plus faible de mortalité que ceux atteints d’une ICFER (rapport de risque [RR] non ajusté 0,85; intervalle de confiance [IC] à 95 % 0,74-0,99). De 1996 à 2009, la tendance séculaire de la mortalité avait diminué chez les patients sans coronaropathie et qui avaient une FE réduite (RR 0,92; IC à 95 % 0,88-0,97), mais non chez ceux qui avaient une FE préservée (RR 0,99; IC à 95 % 0,93-1,05; valeur P de l’interaction 0,095). Aucun résultat n’était significatif après l’ajustement multivarié en fonction du risque. Les résultats étaient cohérents lorsque la FE préservée était définie par une FE ≥ 50 %. Conclusions: Chez les patients sans coronaropathie importante, ceux atteints d’une ICFEP avaient des risques similaires de mortalité dans les cinq ans aux patients atteints d’ICFER.

Introducción. El trabajo aborda un resultado del proyecto de investigación Educación para la vida ciudadana en la formación docente y la escuela, desde los aportes de Martí y Fidel (2018-2020), focalizando los fundamentos esenciales del concepto de Educación para la vida ciudadana, introducido en el actual perfeccionamiento del Sistema Nacional de Educación, como expresión del concepto martiano de que Educar es preparar al hombre para la vida. El objetivo fue valorar la importancia de la educación para la vida ciudadana en el contexto educativo cubano. Métodos. La concepción dialéctico materialista del conocimiento científico aporta la metodolgía general para el estudio y transformación de la realidad, en este caso en el área de las ciencias sociales y humanísticas, en el campo de la pedagogía como ciencia de la educación integral de la personalidad y núcleo de las ciencias de la educación. Lo lógico-histórico, para destacar los momentos nodales del objeto de estudio. Analítico-sintético, en el estudio de los elementos y factores implicados en este complejo proceso formativo. El análisis de fuentes documentales, la observación. Resultado y discusión. El estudio realizado posibilitó realizar la sistematización sobre los fundamentos de una concepción pedagógica sobre la formación ciudadana para las carreras pedagógicas, los aspectos distintivos de este proceso formativo y la introducción en el currículo del plan de estudios E como parte del perfeccionamiento de la educación superior, en este caso para las carreras pedagógicas, dando respuesta a la formación de profesores de la carrera de marxismo leninismo e historia para secundaria básica y el pre universitario, que imparten las asignaturas de educación moral y ciudadana, cultura política, fundamentos ideológicos de la Revolución cubana y construcción del socialismo cubano.

Background Sacubitril/Valsartan has been highly efficacious in randomized trials of heart failure with reduced ejection fraction (HFrEF). However, the effectiveness of sacubitril/valsartan in older patients hospitalized for HFrEF in real‐world US practice is unclear. Methods and Results This study included Medicare beneficiaries age ≥65 years who were hospitalized for HFrEF ≤40% in the Get With The Guidelines–Heart Failure registry between October 2015 and December 2018, and eligible for sacubitril/valsartan. Associations between discharge prescription of sacubitril/valsartan and clinical outcomes were assessed after inverse probability of treatment weighting and adjustment for other HFrEF medications. Overall, 1551 (10.9%) patients were discharged on sacubitril/valsartan. Of those not prescribed sacubitril/valsartan, 7857 (62.0%) were prescribed an angiotensin‐converting enzyme inhibitor/angiotensin II receptor blocker. Over 12‐month follow‐up, compared with a discharge prescription of angiotensin‐converting enzyme inhibitor/angiotensin II receptor blocker, sacubitril/valsartan was independently associated with lower all‐cause mortality (adjusted hazard ratio [HR], 0.82; 95% CI, 0.72–0.94; P=0.004) but not all‐cause hospitalization (adjusted HR, 0.97; 95% CI, 0.89–1.07; P=0.55) or heart failure hospitalization (adjusted HR, 1.04; 95% CI, 0.91–1.18; P=0.59). Patients prescribed sacubitril/valsartan versus those without a prescription had lower risk of all‐cause mortality (adjusted HR, 0.69; 95% CI, 0.60–0.79; P

There is limited empirical evidence of the health effects of war-related violence on child nutritional status. Using unique micro-level data from Iraq, we create measures of cumulative exposure to violence since conception for children ages two to five based on their date of birth and geographic location. We examine the relationship between height-for-age z-scores, a measure of chronic malnutrition, and four indicators of violence in a regression framework, adjusting for potential confounders and trends. We find that a child exposed to the maximum number of violent incidents is likely to experience a 0.5 standard deviation reduction in height-for-age z-score compared to a child who is exposed to no incidents. Each type of attack we evaluate is negatively associated with height-for-age. Further analysis reveals that the associations are the strongest for children in the northern and central regions where the bulk of the violent incidents occurred. Contrary to our expectation, the associations are similar for boys and girls. Our findings suggest that, in addition to efforts aimed at decreasing violent conflict in Iraq in general, the government and its development partners should focus relief, recovery, and reconstruction efforts in the central and northern regions of the country.

El trabajo deriva del proyecto de investigación sobre la “Educación para la vida ciudadana en la formación docente”, en el análisis de la política cubana de enfrentamiento de la Covid 19 y el lugar y papel de la Educación en este contexto.