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Monitored anesthesia care (MAC) has been increasingly utilized in anesthesia services for diagnostic or therapeutic procedures for various non-surgical and surgical procedures in the last several decades [1]. It is also steadily increasing in demand by many different medical specialties: cardiology for cardioversion, defibrillation, transesophageal echocardiography, pacemaker/defibrillator implantation or removal, cardiac catheterization, and other cardiac monitoring devices; gastroenterology for endoscopic examinations, potential biopsies, and other therapeutic interventions; urology for cystoscopy, etc. [1, 2]. MAC has also been gradually applied for more complex procedures in patients receiving endovascular aortic stent placements, transcatheter aortic valve replacements, and even sophisticated procedures like Mitroclip. The aims of MAC for procedures are to enhance patient comfort and cooperation, maintain airway patency and hemodynamic stability, thus facilitating efficient and safe completion of the scheduled procedures.
Humanitarian mine action (HMA) stakeholders have an organized presence with well-resourced medical capability in many conflict and post-conflict settings. Humanitarian mine action has the potential to positively augment local trauma care capacity for civilian casualties of explosive ordnance (EO) and explosive weapons (EWs). Yet at present, few strategies exist for coordinated engagement between HMA and the health sector to support emergency care system strengthening to improve outcomes among EO/EW casualties.
Methods:
A scoping literature review was conducted to identify records that described trauma care interventions pertinent to civilian casualties of EO/EW in resource-constrained settings using structured searches of indexed databases and grey literature. A 2017 World Health Organization (WHO) review on trauma systems components in low- and middle-income countries (LMICs) was updated with additional eligible reports describing trauma care interventions in LMICs or among civilian casualties of EO/EWs after 2001.
Results:
A total of 14,195 non-duplicative records were retrieved, of which 48 reports met eligibility criteria. Seventy-four reports from the 2017 WHO review and 16 reports identified from reference lists yielded 138 reports describing interventions in 47 countries. Intervention efficacy was assessed using heterogenous measures ranging from trainee satisfaction to patient outcomes; only 39 reported mortality differences. Interventions that could feasibly be supported by HMA stakeholders were synthesized into a bundle of opportunities for HMA engagement designated links in a Civilian Casualty Care Chain (C-CCC).
Conclusions:
This review identified trauma care interventions with the potential to reduce mortality and disability among civilian EO/EW casualties that could be feasibly supported by HMA stakeholders. In partnership with local and multi-lateral health authorities, HMA can leverage their medical capabilities and expertise to strengthen emergency care capacity to improve trauma outcomes in settings affected by EO/EWs.
Herbicides have been placed in global Herbicide Resistance Action Committee (HRAC) herbicide groups based on their sites of action (e.g., acetolactate synthase–inhibiting herbicides are grouped in HRAC Group 2). A major driving force for this classification system is that growers have been encouraged to rotate or mix herbicides from different HRAC groups to delay the evolution of herbicide-resistant weeds, because in theory, all active ingredients within a herbicide group physiologically affect weeds similarly. Although herbicide resistance in weeds has been studied for decades, recent research on the biochemical and molecular basis for resistance has demonstrated that patterns of cross-resistance are usually quite complicated and much more complex than merely stating, for example, a certain weed population is Group 2-resistant. The objective of this review article is to highlight and describe the intricacies associated with the magnitude of herbicide resistance and cross-resistance patterns that have resulted from myriad target-site and non–target site resistance mechanisms in weeds, as well as environmental and application timing influences. Our hope is this review will provide opportunities for students, growers, agronomists, ag retailers, regulatory personnel, and research scientists to better understand and realize that herbicide resistance in weeds is far more complicated than previously considered when based solely on HRAC groups. Furthermore, a comprehensive understanding of cross-resistance patterns among weed species and populations may assist in managing herbicide-resistant biotypes in the short term by providing growers with previously unconsidered effective control options. This knowledge may also inform agrochemical company efforts aimed at developing new resistance-breaking chemistries and herbicide mixtures. However, in the long term, nonchemical management strategies, including cultural, mechanical, and biological weed management tactics, must also be implemented to prevent or delay increasingly problematic issues with weed resistance to current and future herbicides.
Background: Extrapulmonary nontuberculous mycobacteria (ENTM) infections are difficult to treat and often require prolonged therapy or surgery. Few population-based studies describe ENTM epidemiology, though well-known healthcare-associated outbreaks have occurred. Using the first year of multi-site ENTM surveillance, we characterized rates and how frequently ENTM infections may be related to healthcare. Methods: CDC’s Emerging Infections Program conducted active, laboratory- and population-based surveillance for ENTM cases in 4 sites (Colorado [5 counties], Minnesota [statewide], New York [1 county], and Oregon [statewide]) in 2021. An incident ENTM case was NTM isolation from a non-pulmonary specimen, excluding stool or rectal swabs, in a resident of the surveillance area without either medical record documentation of prior ENTM infection or isolation of ENTM in the prior 12 months. Demographic, clinical, information on selected healthcare and community exposures, and laboratory data were collected via medical record review. We calculated incidence per 100,000 population using U.S. Census population estimates and performed descriptive analyses. Results: A total of 180 incident ENTM cases were reported in 2021. The crude annual incidence rate was 1.3 per 100,000 persons. Incidence increased with age (from 0.95 per 100,000 among 0–17 year-olds to 2.65 per 100,000 among persons ≥65), ranged from 0.8 among non-Hispanic Asian persons to 1.6 per 100,000 in non-Hispanic Black persons, and was similar among males (1.3 per 100,000) and females (1.4 per 100,000; Figure 1). Mycobacterium avium complex (64 [35.6%]) was the most frequently isolated species group, followed by Mycobacterium chelonae complex (31 [17.2%]). Skin and soft tissue infections were the most frequent infection type (37 [20.6%]); 27 cases (15.0%) were associated with disseminated and/or only bloodstream infection, and 56 cases (31.1%) had no infection type documented. Among 93 cases with localized ENTM infections (i.e., infections that were not disseminated and/or only bloodstream infections), 38.7% had only healthcare-related exposures, 14% had only community-related exposures and 6.5% had both exposure types at the site of infection (Figure 2). Healthcare-related exposures at the infection site included surgery (23.7%), injection/infusion (21.5%), and medical devices (18.3%). The most frequent community-related exposure at the infection site was trauma (17.2%). Only one case was part of a known outbreak, which was healthcare-associated. Conclusions: ENTM infections are relatively rare, but nearly half of patients with localized ENTM infections had prior healthcare-related exposures. This indicates that the burden of ENTM infections related to healthcare may be much larger than what has been suggested from reported outbreaks.
Iron (Fe) deficiency anaemia is a public health concern among adolescent girls worldwide. Food-to-food fortification may be a sustainable and effective solution to Fe deficiency anaemia. However, the effect of food-to-food fortification on Fe deficiency anaemia reduction is understudied particularly in Ghana. This study seeks to investigate the efficacy of baobab pulp-fortified pearl millet beverage powder in improving the Fe and anaemia status of adolescent girls in Ghana. A three-arm cluster randomised controlled trial design, which will involve 258 anaemic adolescent girls (86/arm) selected through multi-stage cluster sampling in Kumbungu District of Ghana, will be used. Participants in arm 1 will receive 350 ml of baobab pulp-fortified pearl millet beverage, containing 13 mgFe (96 % of average RDA), 18·8 mg vitamin C (30·4 % of average RDA) and 222·1 mg citric acid, while participants in arm 2 will receive similar volume of unfortified pearl millet beverage, once a day, five times a week, for six months. Participants in arm 3 will receive the routine weekly Fe (60 mg)-folate (400 μg) supplementation for six months. Serum ferritin, C-reactive protein and haemoglobin (Hb) of participants will be assessed at baseline and end-line. The primary outcomes will be serum ferritin and Hb concentrations. Secondary outcomes will be prevalence of Fe deficiency, Fe deficiency anaemia and BMI-for-age. One-way ANOVA and paired t test will be used to compare means of serum ferritin and Hb levels among and within groups, respectively. This study will provide novel concrete evidence on the efficacy of pearl millet-baobab pulp beverage powder in improving Fe and anaemia status of adolescent girls.
The crystal structure of a synthetic boehmite sample has been refined to an R of 0.047 in the space group Amam from X-ray powder diffraction data. Inclusion of hydrogen atoms and/or refinement in the space group A21am gave poorer results. Cell dimensions were determined as a = 3.6936 (± 0.0003), b = 12.214 (± 0.001), c = 2.8679 (± 0.0003) Å. All Al-O(OH) distances lie between 1.88 and 1.91 Å. Shared octahedral edges are 2.51–2.52 Å, and unshared octahedral edges are 2.86–2.87 Å, in excellent agreement with those for layered silicates. The O-H … O distance between contiguous octahedral sheets is 2.71 Å. The computed X-ray pattern matches closely with the experimental pattern, indicating the degree to which the crystal structure has been determined.
New health care devices, including at-home diagnostic devices, are generating and aggregating data on patients’ health at a staggering pace. Yet much of that data is inaccessible because it is held in data siloes, most often cloud services controlled by device manufacturers. This proprietary siloing of patient data is problematic from ethical, economic, scientific, and broad public policy perspectives. This chapter frames these concerns and begins to sketch a regulatory framework for patient access to health care device data. As with other consumer data, breaking down siloes and securing patients’ access to their device data safeguards patients’ ownership interests, promotes patients’ ability to maintain and repair their equipment, and encourages interoperability and competition. Yet, data access is especially important for health data: It allows patients to make informed decisions about their own care, and it enables motivated citizen-scientists to study their own conditions and innovate in response to them. Patient access to device data may also be a first step toward building publicly accessible, responsibly governed datasets of so-called “real-world evidence” – which are increasingly essential to validate the accuracy and reliability of current diagnostic devices – and to invent and validate future devices, drugs, and other precision medicine interventions. These interests motivate the development of our proposed framework. Drawing from related experiences with clinical trial data and electronic health records, this chapter identifies the key considerations for a framework that protects key interests, such as privacy and data security, while unlocking the benefits of broader data sharing.
OBJECTIVES/GOALS: Clinical and translational science needs to address roadblocks to translational processes. We conducted a survey at two institutions, a private medical school and a large public university, to understand the frequency and distribution of barriers and roadblocks to research. METHODS/STUDY POPULATION: We reviewed the literature to compile a pool of barriers and roadblocks and convened a panel of relevant stakeholders to develop a 20-item questionnaire. Survey respondents were asked to select and prioritize the five leading clinical and translational roadblocks, provide information regarding their academic degrees and rank/position, complete open-ended items regarding their areas of research, and optionally add additional remarks in a comment box. The survey was disseminated in August 2022 via REDCap to faculty and staff with active research protocols at Baylor College of Medicine and the University of Houston. RESULTS/ANTICIPATED RESULTS: In total, 227 respondents completed the survey. Their disciplines were basic science (29.5%), translational research (52.9%), clinical research (55.5%), community-engaged research (9.7%), and educational research (9.7%). Respondents identified 1) lack of access to trained research coordinators, 2) lack of understanding about different resources that facilitate research, 3) complex regulatory environment and delays, 4) fragmented infrastructure for administrative and fiscal processes, and 5) inadequate funding for pilot projects to foster new research. Other roadblocks included lack of established community stakeholder partnerships, inadequate access to medical record data, and limited biostatistical support. In the comments, several respondents noted that all items included were important. DISCUSSION/SIGNIFICANCE: Research workforce recruitment/training was the highest priority followed by lack of access to information and administrative bottlenecks. We are building an online portal to increase awareness and simplify access to competency-based training and research services. Initiatives are underway to address other roadblocks.
The crystal structure of a deuterated synthetic boehmite powder, γ-AIOOD, has been determined by time-of-flight neutron diffraction and Rietveld profile refinement in space group Cmcm to a weighted profile R of 3.71%. Cell dimensions are a = 2.868(1), b = 12.2336(4), and C = 3.6923(1) Å. Alternate space groups for the boehmite structure suggested in the recent literature were found to be unacceptable. Atom positions, bond distances, and angles, with the exception of those involving hydrogen, were nearly identical to those determined by R. J. Hill in 1981 who studied a single crystal of boehmite by X-ray diffraction. All atoms were refined with anisotropic thermal parameters. The b value is 0.013 Å larger, and the thermal ellipsoids of oxygen are slightly more anisotropic than those reported by Hill and may reflect the different samples studied.
A thorough knowledge of gross human neuroanatomy is important in understanding basic and clinical neuroscience. In this chapter we describe the key anatomical features of the human brain followed by a discussion on the main developmental processes and signaling mechanisms of neurogenesis and embryology. Finally, we introduce the reader to different model organisms commonly used in neuroscience research.
Sleep problems associated with poor mental health and academic outcomes may have been exacerbated by the COVID-19 pandemic.
Aims
To describe sleep in undergraduate students during the COVID-19 pandemic.
Method
This longitudinal analysis included data from 9523 students over 4 years (2018–2022), associated with different pandemic phases. Students completed a biannual survey assessing risk factors, mental health symptoms and lifestyle, using validated measures. Sleep was assessed with the Sleep Condition Indicator (SCI-8). Propensity weights and multivariable log-binomial regressions were used to compare sleep in four successive first-year cohorts. Linear mixed-effects models were used to examine changes in sleep over academic semesters and years.
Results
There was an overall decrease in average SCI-8 scores, indicating worsening sleep across academic years (average change −0.42 per year; P-trend < 0.001), and an increase in probable insomnia at university entry (range 18.1–29.7%; P-trend < 0.001) before and up to the peak of the pandemic. Sleep improved somewhat in autumn 2021, when restrictions loosened. Students commonly reported daytime sleep problems, including mood, energy, relationships (36–48%) and concentration, productivity, and daytime sleepiness (54–66%). There was a consistent pattern of worsening sleep over the academic year. Probable insomnia was associated with increased cannabis use and passive screen time, and reduced recreation and exercise.
Conclusions
Sleep difficulties are common and persistent in students, were amplified by the pandemic and worsen over the academic year. Given the importance of sleep for well-being and academic success, a preventive focus on sleep hygiene, healthy lifestyle and low-intensity sleep interventions seems justified.
We examined the effect of an antimicrobial stewardship program (ASP), procalcitonin testing and rapid blood-culture identification on hospital mortality in a prospective quality improvement project in critically ill septic adults. Secondarily, we have reported antimicrobial guideline concordance, acceptance of ASP interventions, and antimicrobial and health-resource utilization.
CHD care is resource-intensive. Unwarranted variation in care may increase cost and result in poorer health outcomes. We hypothesise that process variation exists within the pre-operative evaluation and planning process for children undergoing repair of atrial septal defect or ventricular septal defect and that substantial variation occurs in a small number of care points.
Methods:
From interviews with staff of an integrated congenital heart centre, an initial process map was constructed. A retrospective chart review of patients with isolated surgical atrial septal defect and ventricular septal defect repair from 7/1/2018 through 11/1/2020 informed revisions of the process map. The map was assessed for points of consistency and variability.
Results:
Thirty-two surgical atrial septal defect/ventricular septal defect repair patients were identified. Ten (31%) were reviewed by interventional cardiology before surgical review. Of these, 6(60%) had a failed catheter-based closure and 4 (40%) were deemed inappropriate for catheter-based closure. Thirty (94%) were reviewed in case conference, all attended surgical clinic, and none were admitted prior to surgery. The process map from interviews alone identified surgery rescheduling as a point of major variability; however, chart review revealed this was not as prominent a source of variability as pre-operative interventional cardiology review.
Conclusions:
Significant variation in the pre-operative evaluation and planning process for surgical atrial septal defect/ventricular septal defect patients was identified. If such process variation is widespread through CHD care, it may contribute to variations in outcome and cost previously documented within CHD surgery. Future research will focus on determining whether the variation is warranted or unwarranted, associated health outcomes and cost variation attributed to these variations in care processes.
We investigate the role of optimism bias in bull price expectations using incentivized lab-in-the-field experiments with Alabama and Tennessee cattle producers. We develop bull price prediction tasks and reward accurate predictions. We find that the EPD information provision prevents optimism bias from contaminating price expectations in the whole sample. However, we also document that, unlike buyers, sellers are prone to unrealistic optimistic expectations, and our results reveal that optimism bias can be moderated by the type of expected progeny difference information utilized, breed characteristics, and regional differences in cattle operations. We contribute to the literature by documenting the role of behavioral biases.
We determine optimal stocker strategies based on calving season, herd size, and the number of days of retention before marketing weaned calves. We estimate a hedonic pricing model for feeder cattle and incorporate this into a simulation model that considers the variability of cattle prices and feed costs. The profit and utility-maximizing decision for fall calving herd would be to retain weaned calves for 150-day postweaning. The producer marketing spring-born calves would prefer to sell these calves at weaning. The results are being utilized by extension to aid cattle producers in reducing their feed costs and increasing their profits.
The winemaking technique of saignée is common for some varietals, and the ensuing flavor profiles have been carefully analyzed by oenologists. However, we argue that saignée is fundamentally about economic tradeoffs between the quantity of primary wine that is ultimately produced, the quality (and thus, price) of that wine, and the amount of rosé wine that is bled off in the process. We develop the first theoretically-grounded economic model of saignée and analyze the model to shed light on the winemaker's optimal choice of saignée, and on the properties of wine and wine markets that should empirically give rise to more, or less, saignée. The model helps to explain several real-world regularities such as the absence of saignée for most Bordeaux wines, the specialization in rosé for many wines in Provence, and the practice of moderate amounts of saignée for varietals such as grenache and pinot noir.
With advances in care, an increasing number of individuals with single-ventricle CHD are surviving into adulthood. Partners of individuals with chronic illness have unique experiences and challenges. The goal of this pilot qualitative research study was to explore the lived experiences of partners of individuals with single-ventricle CHD.
Methods:
Partners of patients ≥18 years with single-ventricle CHD were recruited and participated in Experience Group sessions and 1:1 interviews. Experience Group sessions are lightly moderated groups that bring together individuals with similar circumstances to discuss their lived experiences, centreing them as the experts. Formal inductive qualitative coding was performed to identify salient themes.
Results:
Six partners of patients participated. Of these, four were males and four were married; all were partners of someone of the opposite sex. Themes identified included uncertainty about their partners’ future health and mortality, becoming a lay CHD specialist, balancing multiple roles, and providing positivity and optimism. Over time, they took on a role as advocates for their partners and as repositories of medical history to help navigate the health system. Despite the uncertainties, participants described championing positivity and optimism for the future.
Conclusions:
In this first-of-its-kind pilot study, partners of individuals with single-ventricle CHD expressed unique challenges and experiences in their lives. There is a tacit need to design strategies to help partners cope with those challenges. Further larger-scale research is required to better understand the experiences of this unique population.