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Background: Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) are two commonly used cognitive screening and diagnostic tools. Objective: Our goal was to assess their efficacy for monitoring cognitive changes, as well as the correlation between the two tests. Methods: At baseline, participants in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) were divided into four groups based on their cognitive diagnoses: healthy control (HC), early mild cognitive impairment (EMCI), late mild cognitive impairment (LMCI), and Alzheimer’s disease (AD). MMSE or MoCA scores were compared among the four groups using an analysis of variance (ANOVA) model with repeated measures with post-hoc Bonferroni correction. For those participants who had both MMSE and MoCA assessments done, a Pearson correlation analysis was performed between the two assessments for each visit. Results: The MMSE scores were significantly different among the four groups at baseline, which was true for each of the three annual follow-up visits. By contrast, the MoCA scores were not significantly different between HC and EMCI groups at either baseline or any of the follow-up visits. For participants with a diagnosis of LMCI, the cognitive performance deteriorated in a linear manner 12 months after the baseline, which was independent of MMSE or MoCA. At last, the MMSE scores were moderately related to MoCA scores, which got stronger along with the time of follow-up. Conclusion: MMSE and MoCA are comparable as cognitive assessment tools to monitor cognitive changes. In addition, the measurements of MMSE and MoCA are moderately correlated for the follow-up visits.

Liver disease in children with Turner Syndrome (TS) is poorly understood relative to associated growth, cardiac and reproductive complications. This study sought to better characterize hepatic abnormalities in a large national cohort of youth with TS.Using electronic health record data from PEDSnet institutions, 2145 females with TS were matched to 8580 females without TS on eight demographic variables. Outcomes included liver enzymes (AST and ALT) stratified as normal, 1-2 times above the upper limit of normal (ULN), 2-3 times ULN and 3 times ULN, as well as specific liver disease diagnoses.Fifty-eight percent of youth with TS had elevated liver enzymes. Patients with TS had higher odds of enzymes 1-2 times ULN (OR: 1.7, 95% CI: 1.4-1.9), 2-3 times ULN (OR: 2.7, 95% CI: 1.7-3.3) and 3 times ULN (OR: 1.7, 95% CI: 1.3-2.2). They also had higher odds of any liver diagnosis (OR: 2.4, 95% CI: 1.7-3.3), fatty liver disease (OR: 1.9, 95% CI: 1.1-3.2), hepatitis (OR: 3.7, 95% CI: 1.9-7.1), cirrhosis/fibrosis (OR: 5.8, 95% CI: 1.3-25.0) and liver tumour/malignancy (OR: 4.8, 95% CI: 1.4-17.0). In a multinomial model, age, BMI and presence of cardiovascular disease or diabetes significantly increased the odds of elevated liver enzymes in girls with TS.Youth with TS have higher odds for elevated liver enzymes and clinically significant liver disease compared with matched controls. These results emphasize the need for clinical screening and additional research into the aetiology and treatment of liver disease in TS.Turner Syndrome, a chromosomal condition in which females are missing the second sex chromosome, is often associated with short stature, infertility and cardiac complications. Liver abnormalities are less well described in the literature. In this study, nearly 60% of youth with TS have elevated liver enzymes. Furthermore, patients with TS had a diagnosis of liver disease more often than patients without TS. Our results support the importance of early and consistent liver function screening and of additional research to define mechanisms that disrupt liver function in paediatric TS females.

Purpose Infective endocarditis (IE) is a rare but potentially fatal complication following heart transplantation (HTx). There is a lack of literature regarding the patterns and clinical course of IE development following HTx. We sought to pool the existing data in regards to defining characteristics, management options, and outcomes of IE following HTx. Methods An electronic search of Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, and the Scopus databases were performed to identify all articles in the English literature that report IE following HTx in adult patients. Patient-level data were extracted and analyzed. Results Systematic search yielded 57 patients from 32 articles. Median patient age was 52 [IQR 43, 59] and 75% of patients (43/57) were male. Median time to IE presentation post-HTx was 8.4 [IQR 3.0, 35.8] months. IE of the mitral valve was observed in 36.8% (21/57) of patients, followed by mural IE in 24.6% (14/57), and tricuspid valve IE in 21.1% (12/57). The most common organisms were Staphylococcus aureus in 26.3% (15/57), Aspergillus fumigatus in 19.3% (11/57), Enterococcus faecalis in 12.3% (7/57), and an undetermined or unspecified organism in 14.0% (8/57) patients. Overall case fatality was 44.6% (25/56). Fungal IE was associated with a significantly higher case fatality 75.0% (9/12) than that of bacterial IE 36.1% (13/36) (p = 0.02). Surgical management of post-HTx IE was observed in 35.1% (20/57) of patients. This included valve surgery for 70.0% (14/20), including the mitral valve in 50.0% (7/14), aortic valve in 35.7% (5/14), and the tricuspid valve in 14.3% (2/14) of patients. Conclusion In addition to bacterial organisms, fungi also represent a frequent cause of IE in post-HTx patients. Overall HTx patient survival in the setting of IE is poor and may be worse if caused by A. fumigatus.

The absence of scholarship on South Asian discrimination in Western queer discourse contributes to a narrative that South Asians are not subjected to racially charged forms of discrimination in the LGBTQ community, which is fundamentally untrue. This article presents narrative-based accounts of nine queer South Asian women in Toronto, Canada, to examine the ways in which they experience racial discrimination in the LGBTQ community, and the impact that this mistreatment has on identity formation and connectivity to queer spheres. It finds that queer South Asian women experience racial discrimination in the form of racially charged microaggressions, which are evidenced through expectations of assimilation to Western-normative performances of queer identity and erasure of South Asian culture in the LGBTQ community. Further, it reveals that Toronto's LGBTQ community perpetuates a culture of White privilege that discredits the intersectional identity of queer South Asian women, and consequently invisibilizes, alienates, and revokes agency from these women who do not fit the majority's conceptualizations about what a queer woman looks like.

Objective Gastroparesis is a debilitating condition that causes nausea, vomiting, and abdominal pain. Management includes analgesics and antiemetics, but symptoms are often refractory. Haloperidol has been utilized in the palliative care setting for similar symptoms. The study objective was to determine whether haloperidol as an adjunct to conventional therapy would improve symptoms in gastroparesis patients presenting to the emergency department (ED). Study Design and Methods This was a randomized, double-blind, placebo-controlled trial of adult ED patients with acute exacerbation of previously diagnosed gastroparesis. The treatment group received 5 mg of haloperidol plus conventional therapy (determined by the treating physician). The control group received a placebo plus conventional therapy. The severity of each subject's abdominal pain and nausea were assessed before intervention and every 15 minutes thereafter for 1 hour using a 10-point scale for pain and a 5-point scale for nausea. Primary outcomes were decreased pain and nausea 1 hour after treatment. Results Of the 33 study patients, 15 were randomized to receive haloperidol. Before treatment, the mean intensity of pain was 8.5 in the haloperidol group and 8.28 in the placebo group; mean pretreatment nausea scores were 4.53 and 4.11, respectively. One hour after therapy, the mean pain and nausea scores in the haloperidol group were 3.13 and 1.83 compared to 7.17 and 3.39 in the placebo group. The reduction in mean pain intensity therapy was 5.37 in the haloperidol group (p ≤ 0.001) compared to 1.11 in the placebo group (p = 0.11). The reduction in mean nausea score was 2.70 in the haloperidol group (p ≤ 0.001) and 0.72 in the placebo group (p = 0.05). Therefore, the reductions in symptom scores were statistically significant in the haloperidol group but not in the placebo group. No adverse events were reported. Conclusions Haloperidol as an adjunctive therapy is superior to placebo for acute gastroparesis symptoms.

Biological aging is a risk factor for the development of cardiovascular disease. The changes in the normal immune cell phenotype and function in the myocardium due to immunosenescence is the major source for cardiac distress. Cardiac resident macrophages in the heart play a critical role in the maintenance of homeostatic functions and tissue repair during myocarditis. Recently, we have demonstrated that non-tuberculosis Mycobacterium avium (NTM- common in lung infections in the elderly population in the U.S.) infection predisposes the aged mice to cardiac dysfunction; however the mechanism is not known. Here, we investigated the various subsets of myeloid cells and their contribution to the heart function in old mice. We infected young (10 weeks) and old mice (18 months) with NTM and characterized the resident and infiltrated myeloid cells. Our results revealed that before infection old mice showed elevated numbers of myeloid cells in heart tissue compared to young mice. In contrast, NTM infection (30 day post infection) significantly increased the frequency of different myeloid cell subsets in the young mice. Although, the number of cardiac macrophages in young and old mice are not significantly different in infected and uninfected mice, we found that MHCII low macrophages (cardiac resident) are significantly higher in the heart tissue of old mice than young mice before infection which significantly decreased after infection. Interestingly, we observed that MHCII high and MerTK + macrophage (infiltrated macrophages) populations are increased in young and old mice but with a higher rate in young mice. Notably, we found that the number of myeloid-derived suppressor cells (MDSCs) in the heart of aged mice is decreased by infection, which was increased in young mice. In conclusion our data indicates that the NTM infection alters the myeloid cell population and function in the aged heart and failed to maintain the normal heart function, where as in young mice, infection leads to the recruitment of myeloid cells which help to confront the infection and maintain the normal heart function. Further MDSCs accumulation in the heart of young mice after infection is responsible for anti-inflammatory effects to control the hypertrophy, fibrosis and inflammation.

Trigeminal neuralgia is a chronic pain disorder affecting the trigeminal nerve which usually worsens with passage of time. It is an episodic pain syndrome which has been fairly responsive to medical & surgical treatment modalities. It is a pathology characterized by paroxysmal pain so severe and sudden almost like an electric shock, which lasts from a range of very few seconds to a maximum of two minutes. The article is focused on different treatment modalities and their subsequent prognosis.

Fulminant hepatic failure secondary to herpes simplex virus (HSV) is a rare complication that is associated with high mortality. Here, we describe the case of a critically ill patient with severe burns and inhalation injury who developed severe coagulopathy during her hospital stay, which was later found to be caused by HSV hepatitis. In addition, we review the current literature on HSV hepatitis. Only three prior reports document liver involvement of HSV in patients with burn. Clinical symptoms, diagnostic factors, and management of HSV hepatitis in patients with burn are presented. Because of severe immunosuppression and potentially fatal nature of this infection, clinicians should have a heightened suspicion for HSV hepatitis in burn patients with HSV mucocutaneous involvement, unexplained liver dysfunction, and severe coagulopathy, and it should prompt immediate initiation of intravenous acyclovir.

Voices of Youth Count (VoYC) is a mixed-methods, multicomponent study that documents the prevalence and incidence rates of homeless youth in the United States, and describes the population’s characteristics, service gaps, and interventions of selected communities. The study uses a definition of youth homelessness that is broader than the definition in use by HUD, and includes both explicit homelessness (i.e. youth living on the street, in shelters, and in transitional housing) and unstably housed youth who are couch surfing or precariously housed. Due in part to the broader definition of homelessness utilized, the study finds that one in 30 youth ages 13-25 experienced some form of homelessness during the previous year. The study also identifies several high-risk homeless youth subpopulations, observes comparable rates of youth homelessness in rural and urban areas, and develops a rigorous methodology for future counts of homeless youth.

Dermoscopy is the in vivo technique of skin surface microscopy which is frequently used in visual examination of the skin. With the rise in the usage of smartphones, many smartphone attachments have been developed that enable dermoscopy on a phone but these attachments are very expensive and are available only for high-end phones. We have developed a novel 3D printed clip-on that can convert any smartphone into a polarizing dermoscope at a price which is highly affordable than the existing devices and is universal in its design. After visual examination and comparing images taken by both the devices using Structural Similarity Index (SSIM), we found the images to be highly similar. This clip-on for smartphones is one of the first prototypes using techniques of 3D printing which can make dermoscopy affordable, especially in developing countries like India. There is an acute need for such devices by clinicians practicing in remote areas, where such clip-ons can help in improving the preliminary visual examination of a large number of patients.

Introduction Second AutoSCT has been demonstrated to be beneficial in pts with relapsed multiple myeloma (rMM), in clinical trials. The optimal conditioning regimen for pts who receive a second transplant has not been currently established. We report our experience using an alternative conditioning regimen (ACR) with either bortezomib with high-dose melphalan (Bor.mel) or carmustine with high-dose melphalan (BCNU.mel), versus single-agent HDM in pts receiving a second AutoSCT for rMM. Methods Data was retrospectively collected and analyzed from all pts who received Bor.mel, BCNU.mel (dosing previously reported), and HDM (melphalan 140 mg/m2 or 200 mg/m2 IV) as conditioning prior to second AutoSCT for rMM at our institution. Demographics, disease risk status at initial diagnosis, disease status prior to and response to second AutoSCT, transplant related adverse events and outcomes were analyzed. Fisher's exact test was used to compare response rates between groups. Results Between 2012-2016, 82 adult pts received a second AutoSCT (50 HDM pts, 32 AC pts). The median age was 59 years in the HDM arm and 56 years in the ACR arm. The ACR arm had more high risk pts [7 (22%) vs 2 (4%)]; however, the majority of pts in both arms had standard risk rMM. All patients received HDM as conditioning with first AutoSCT. A complete remission at day 100 was observed in 19 (38%) HDM pts vs 11 (34%) ACR pts; VGPR in 23 (46%) HDM vs 12 (38%) ACR; PR 3 (6%) HDM vs 7 (22%) ACR; SD 1 (2%) HDM vs 1 (3%) ACR; and PD in 2 (4%) HDM vs 1 (3%) ACR. Two patients in the HDM arm were not evaluable at day 100 (1 death, 1 lost to follow up). There was a trend towards more favorable response (stringent CR + CR + VGPR) in patients that received HDM compared to ACR (p = 0.073). Adverse effects were similar between the two groups. The median time to neutrophil (12 days HDM vs 13 days ACR) and platelet engraftment (18 days HDM vs 18 days ACR) were similar. At last follow up, 42 (51.2%) pts were alive, 18 (36%) in the HDM arm and 24 (75%) in the ACR arm. Of the 40 pts that died, cause of death was progressive disease in 8 pts (4 pt in each group), infection related in 5 pts, other causes in 2 pts, and unknown in 25 pts. Conclusions Second autologous stem cell transplant is an effective option for relapsed and refractory multiple myeloma. Based on our analysis, HDM in second AutoSCT was associated with a more favorable response (sCR + CR + VGPR) compared to ACR, however; there were a higher percentage of high risk pts and fewer patients in the ACR arm. Further evaluation with a more robust population size in each group is warranted in addition to evaluating other alternative regimens to determine if a change in conditioning regimen with second autografts would provide better outcomes.

Objectives Children outside of family care face increased risk of threats to their well-being, have lower educational achievement, and experience adverse developmental outcomes. While it is generally accepted that early response and intervention is critical to reducing the risk of harm for children who have been separated from their families, it is not always clear what the most effective early response strategies are for assessing and addressing their immediate needs. The purpose of this review was to identify evidence-based early response strategies and interventions for improving the outcomes of children outside of family care, including children of and on the street, institutionalized children, trafficked children, children affected by conflict and disaster, and who are exploited for their labor. Methods A multi-phased, systematic evidence review was conducted on peer-reviewed and gray literature, which yielded a total of 101 documents that met the inclusion criteria and were reviewed. Results Overall there is a weak evidence base regarding assessment and early response interventions for children living outside of family care. Few studies included careful outcome measures or comparison groups. Although few proven interventions emerged, the review identified several promising early interventions and approaches. In emergency settings, family tracing and reunification is a highly effective response in regard to separated children, whereas placing children in institutional care is problematic, with the possible exception of time-limited placements of formerly recruited children in interim care centers. Livelihood supports are promising in regard to preventing and responding to children living outside family care. Other promising interventions include psychosocial support, including the use of traditional cleansing rituals as appropriate, educational supports such as Child Friendly Spaces, the maintenance of family connectedness for children of or on the streets, the use of community-based approaches that aid social integration, and approaches that enable meaningful child participation. A recurrent theme was that to be effective, all assessments and interventions must fit the context. Conclusion A strong need exists for strengthening the evidence base regarding the effectiveness of early assessments and responses to children living outside family care and for using the evidence to guide operational policy and practice. Recommendations regarding policy, practices, and research emerged from the review process.

We sought to review and analyze the hemodynamic derangements during prograde transcatheter aortic intervention (PTAI) in single ventricle patients.Although PTAI for postsurgical recurrent coarctation in single ventricle patients has been described; hemodynamic instability during the intervention is variably reported.Pre-, intra-, and postprocedural records and outcomes of patients with SVP undergoing PTAI for post-Norwood aortic coarctation were retrospectively reviewed. The full disclosure waveform review was used to further categorize hemodynamic derangements during the intervention.A total of 26 PTAIs were performed in 11 patients between October 2007 and December 2013. The median age and weight was 4.2 (2.3-43) months and 5.3 (3.2-15.7) kg. PTAI included balloon angioplasty (BA) in 73% of procedures (n = 19) and stent implantation (SI) in 27% (n = 7). Hemodynamic derangement was more severe in the SI group compared with the BA group. Two of seven (29%) of the SI group required cardiopulmonary resuscitation.Hemodynamic instability during PTAI is common in patients with SVP and more profound during SI. These findings have important implications for informed consent, anesthetic considerations, inotropic support, additional central venous access, and extracorporeal support/surgical backup.

Men who have sex with men (MSM) are at particular risk for HIV/sexually transmitted infections (STI). To investigate the European guidance used for MSM STI and HIV screening, risk level profiling and how this translated to practice, we conducted a questionnaire survey of leading physicians in the European branch of the International Union against Sexually Transmitted Infections (IUSTI). We identified that most European countries have limited guidance on screening intervals for MSM. Where risk profiling is advised, it is often left to clinicians to weight different behaviours and decide on screening frequency. Our results suggest that European MSM STI and HIV testing guidelines be developed with clear and specific recommendations around screening intervals and risk profiling. These guidelines will be particularly helpful due to rapidly evolving models of sexual healthcare, and the emergence of new providers who may benefit from guidelines that require less interpretation.

Area exploration is the key behind many researches in robotics. Numerous exploration problems have been solved based on the concept of frontiers that can be defined as the boundary between the explored and unexplored cell. In this paper we considered the problem of energy efficient exploration with a team of robots. An approach has been proposed that chooses the next frontier based on the direction strategy which simultaneously takes into account the location of other robot as well. Whenever a frontier has to be assigned to a specific robot, the utility of the unexplored area visible from this position is increased so that at a time not more than single robot moves to the same cell. Based on the direction penalty is calculated for each target points. Then the frontier having minimum utility and penalty has been chosen as the next target point. The robot moves to that frontier cell using energy efficient A* algorithm. The energy efficient A* gives optimal results taking into account energy consumed for stops and turns. Java based platform is used to run the simulation. Proposed algorithm has been tested on various test maps. The result shows that our technique accomplishes the mission quickly as compared to single robot energy efficient exploration and effectively distributes the robots over the environment.

Exploration of an unknown environment by autonomous mobile robot is a fundamental concern in mobile robotics. Today most of the mobile robots are powered by batteries so their energy and operation times are limited. Therefore, how to minimize energy consumption and obstacle avoidance becomes an important problem. Frontier-based method is known to be most efficient for robot exploration system. In this paper, we propose a novel energy efficient platform based on the notion of frontiers for mobile robot. The robot selects the next frontier to visit based on the robot's current direction and relative location of frontier cells. Our frontier selection method can reduce duplicate coverage and thus save energy and reduce the distance also. Distance to frontier are computed using energy efficient A* algorithm. We estimate the energy consumption and choose the most energy-efficient route to move to that frontier considering energy of stop and turnings. We tested the algorithm on various types of environment maps. The experiments were conducted assuming equal velocity for the robot during whole exploration. All paths generated were optimal in terms of energy consumption and turns. The robot was easily able to escape a variety of obstacles and reach the goal in an optimal manner.

We performed micromotion experiments using electric cell-substrate impedance sensing (ECIS) on a confluent layer of 3T3 fibroblasts exposed to different low levels of the toxin cytochalasin B. This toxin is know to affect actin polymerization and to disrupt cytoskeletal structure and function in cells, changing the morphology of confluent cell cultures and altering the nature of the cellular micromotion, which is measured by ECIS as changes in impedance. By looking at several measures to characterize the long- and short-term correlations in the noise of the impedance time series, we are able to detect the effects of the toxin at concentrations down to 1 microM; there are intriguing hints that the effects may be discernible at levels as low as 0.1 microM. These measures include the power spectrum, the Hurst and detrended-fluctuation-analysis exponents, and the first zero and first 1/e crossings of the autocorrelation function. While most published work with ECIS uses only average impedance values, we demonstrate that noise analysis provides a more sensitive probe.

BACKGROUND . Ventricular fibrillation occurs in 10 –20% of pediatric cardiac arrests. Survival rates in children with ventricular fibrillation can be as high as 30% when the rhythm is identified and treated promptly. In the last five years, recommendations have been made for the use of automated external defibrillators(AED) in children 1– 8 years of age. OBJECTIVE . The goal of this study was to determine the awareness of American Heart Association (AHA) guidelines and statewide protocols concerning AED use in children ages 1– 8 among emergency medical providers after new guideline release. Availability of pediatric capable AED equipment was also assessed. METHODS . Surveys were distributed to EMS providers in Iowa and Montana within one year of the AHA advisory statement in 2003 recommending use of AEDs in children ages 1– 8, and again approximately one year after the 2005 AHA guidelines on cardiopulmonary resuscitation were published. In Iowa, there were concentrated efforts to disseminate information about AED use in children, while there were minimal efforts in Montana. RESULTS . Awareness of AHA guidelines for use of AEDs in children was low in both states in 2003 (29% in Iowa vs 9% in Montana, p< 0.001). After release of the 2005 guidelines, awareness improved significantly in both states but was still significantly greater in Iowa (83% vs. 60 %, p < 0.002). In 2003, less than 20% of respondents in both states reported access to pediatric capable AEDs. Availability of pediatric pads and cables increased significantly in 2006 but remained low in Montana (74% in Iowa vs 37% in Montana, p < 0.001). CONCLUSIONS . At the present time, publication of new or interim guidelines in the scientific literature alone is insufficient to ensure that awareness among providers and that new protocols are implemented. An effective and efficient method to disseminate new pediatric out-of-hospital protocols emergency care to become standard of care in a timely matter should be developed.