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The Journal of Extra-corporeal... Jun 2024The Perfusion Measures and Outcomes (PERForm) registry was established in 2010 to advance cardiopulmonary bypass (CPB) practices and outcomes. The registry is maintained...
BACKGROUND
The Perfusion Measures and Outcomes (PERForm) registry was established in 2010 to advance cardiopulmonary bypass (CPB) practices and outcomes. The registry is maintained through the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and is the official registry of the American Society of Extracorporeal Technology.
METHODS
This first annual PERForm registry report summarizes patient characteristics as well as CPB-related practice patterns in adult (≥18 years of age) patients between 2019 and 2022 from 42 participating hospitals. Data from PERForm are probabilistically matched to institutional surgical registry data. Trends in myocardial protection, glucose, anticoagulation, temperature, anemia (hematocrit), and fluid management are summarized. Additionally, trends in equipment (hardware/disposables) utilization and employed patient safety practices are reported.
RESULTS
A total of 40,777 adult patients undergoing CPB were matched to institutional surgical registry data from 42 hospitals. Among these patients, 54.9% underwent a CABG procedure, 71.6% were male, and the median (IQR) age was 66.0 [58.0, 73.0] years. Overall, 33.1% of the CPB procedures utilized a roller pump for the arterial pump device, and a perfusion checklist was employed 99.6% of the time. The use of conventional ultrafiltration decreased over the study period (2019 vs. 2022; 27.1% vs. 24.9%) while the median (IQR) last hematocrit on CPB has remained stable [27.0 (24.0, 30.0) vs. 27.0 (24.0, 30.0)]. Pump sucker termination before protamine administration increased over the study period: (54.8% vs. 75.9%).
CONCLUSION
Few robust clinical registries exist to collect data regarding the practice of CPB. Although data submitted to the PERForm registry demonstrate overall compliance with published perfusion evidence-based guidelines, noted opportunities to advance patient safety and outcomes remain.
Topics: Humans; Registries; Male; Aged; Cardiopulmonary Bypass; Middle Aged; Female; Michigan; Adult
PubMed: 38888548
DOI: 10.1051/ject/2024006 -
Journal of Addiction Medicine Jun 2024With the increasing rates of opioid overdose deaths in the United States, barriers to treatment access for patients seeking medications for opioid use disorder (OUD),...
OBJECTIVES
With the increasing rates of opioid overdose deaths in the United States, barriers to treatment access for patients seeking medications for opioid use disorder (OUD), and challenges of initiating buprenorphine in patients who use fentanyl, it is essential to explore novel approaches to expanding access to methadone treatment. An opioid treatment program (OTP) and a federally qualified health center (FQHC) partnered to develop and implement an innovative integrated methadone and primary care treatment model. The process for integrating an OTP and FQHC to provide methadone treatment in the primary care setting will be discussed.
METHODS
An OTP methadone dispensing site was co-located in the FQHC, utilizing a staffing matrix built on the expertise of each stakeholder. The OTP managed DEA and state regulatory processes, whereas the FQHC physicians provided medical treatment, including methadone treatment protocols, treatment plans, and primary care. Patient demographics, medical history, and retention data for those who entered the program between January 2021 and February 2023 were collected through chart review and analyzed with descriptive statistics.
RESULTS
A total of 288 OTP-FHQC patients were enrolled during the study. Retention rates in methadone treatment at 90 and 180 days were similar to partner clinics.
CONCLUSIONS
Collaboration between FQHCs and OTPs is operationally feasible and can be achieved utilizing the current staffing model of the FQHC and OTP. This model can increase access to treatment for OUD and primary care for an urban, underserved patient population.
PubMed: 38884619
DOI: 10.1097/ADM.0000000000001336 -
Journal of Disability Policy Studies Jun 2024This paper examines current technology-aided instruction and intervention (TAII) available for autistic transition-age youth (TAY) and existing policies that may support...
This paper examines current technology-aided instruction and intervention (TAII) available for autistic transition-age youth (TAY) and existing policies that may support or hinder the delivery of these interventions. Specifically, we focus on policies that might influence the delivery of TAII to autistic TAY. After a careful review of the literature, we observed that postsecondary policy guiding the delivery of TAII designed to support autistic TAY is lacking. TAII have demonstrated effectiveness, usability, sustainability, and cost-effectiveness, particularly with this population. We suggest possibilities for future policies to support the development, implementation, and evaluation of TAII for autistic TAY.
PubMed: 38883993
DOI: 10.1177/10442073221150603 -
International Journal of Biomedical... 2024This paper extends our previous method for COVID-19 diagnosis, proposing an enhanced solution for detecting COVID-19 from computed tomography (CT) images using a lean...
This paper extends our previous method for COVID-19 diagnosis, proposing an enhanced solution for detecting COVID-19 from computed tomography (CT) images using a lean transfer learning-based model. To decrease model misclassifications, two key steps of image processing were employed. Firstly, the uppermost and lowermost slices were removed, preserving sixty percent of each patient's slices. Secondly, all slices underwent manual cropping to emphasize the lung areas. Subsequently, resized CT scans (224 × 224) were input into an Xception transfer learning model with a modified output. Both Xception's architecture and pretrained weights were leveraged in the method. A big and rigorously annotated database of CT images was used to verify the method. The number of patients/subjects in the dataset is more than 5000, and the number and shape of the slices in each CT scan varies greatly. Verification was made both on the validation partition and on the test partition of unseen images. Results on the COV19-CT database showcased not only improvement from our previous solution and the baseline but also comparable performance to the highest-achieving methods on the same dataset. Further validation studies could explore the scalability and adaptability of the developed methodologies across diverse healthcare settings and patient populations. Additionally, investigating the integration of advanced image processing techniques, such as automated region of interest detection and segmentation algorithms, could enhance the efficiency and accuracy of COVID-19 diagnosis.
PubMed: 38883272
DOI: 10.1155/2024/9962839 -
Progress in Brain Research 2024Cardiovascular fitness (CRF) has been consistently linked to cognitive performance and academic achievement, and inhibitory control has been recognized as a key...
Cardiovascular fitness (CRF) has been consistently linked to cognitive performance and academic achievement, and inhibitory control has been recognized as a key predictor of academic success. However, few studies have explored whether inhibitory control mediates the relationship between CRF and academic performance in children, and the existing findings are inconclusive because of certain limitations. This study investigated the mediating role of inhibitory control in the association between CRF and academic achievement among preadolescents while also addressing the related limitations. This study enrolled a total of 175 elementary school students (70 girls, mean age=11.17years, standard deviation=0.7), who participated in a half-mile test for assessing their CRF level. Additionally, inhibitory control was measured using the Stroop Color and Word Test (Stroop test), and language and mathematics tests were administered to measure their academic performance. The results revealed that the participants with higher CRF levels achieved superior performance in tasks requiring a high level of inhibitory control (r=0.291, P<0.001) and in Chinese language (r=-0.415, P<0.001) and mathematics (r=-0.366, P<0.001) tests even when gender, age, and body fat were considered. Furthermore, a mediation analysis revealed that inhibitory control, as measured through the incongruent trials of the Stroop test, partially mediated the relationship between CRF and academic performance (language: indirect effect=-0.013, 95% CI [-0.019, -0.008]; math: indirect effect=-0.013, 95% CI [-0.021, -0.009]). These findings have major implications for child development, emphasizing the key role of inhibitory control in the beneficial effects of CRF on academic achievement.
Topics: Humans; Female; Male; Academic Success; Child; Inhibition, Psychological; Cardiorespiratory Fitness; Executive Function; Stroop Test
PubMed: 38876573
DOI: 10.1016/bs.pbr.2023.11.003 -
Social Science Research Jul 2024This paper examines whether exposure to spatially proximate homicide affects norms, attitudes, and the adaptive strategies adolescents take to insulate themselves from...
This paper examines whether exposure to spatially proximate homicide affects norms, attitudes, and the adaptive strategies adolescents take to insulate themselves from violent victimization. Drawing on survey data from a large sample of urban youth (n = 3195), we assess the impact of homicides occurring within a one-mile radius of respondents' homes on a variety of psychosocial outcomes. We exploit random variation in the timing of survey administration to compare the survey responses of youths who were exposed to a homicide in the immediate vicinity of their homes in the one-month period leading up the administration of the survey with students who did not experience a homicide near their homes during that period but would the following month. This strategic comparison approach minimizes the confounding influence of endogenous processes that funnel children and families into places where homicides tend to concentrate.
PubMed: 38871432
DOI: 10.1016/j.ssresearch.2024.103026 -
Global Health, Science and Practice Jun 2024Nigeria accounts for substantial proportions of global malaria infections and deaths, with children aged younger than 5 years being the most affected group. This...
BACKGROUND
Nigeria accounts for substantial proportions of global malaria infections and deaths, with children aged younger than 5 years being the most affected group. This suggests that access to lifesaving malaria interventions could be suboptimal, especially at public health facilities where most rural dwellers seek health care. We conducted this study to ascertain if public health facilities have the commodities and the robust supply chain management (SCM) system required to deliver malaria interventions to children younger than 5 years.
METHOD
We conducted a cross-sectional survey in 1,858 health facilities across 7 states in Nigeria. Using structured questionnaires, we assessed the availability of selected malaria commodities required by children aged younger than 5 years. We also interviewed health workers to evaluate other core SCM activities.
RESULT
More than 50% of health facilities in 5 states were stocked out of malaria rapid diagnostic tests (mRDTs), and stock-out rates for artemisinin-based combination therapies (ACTs) were over 50% for almost all assessed ACTs across all states. The percentage of health facilities that received malaria commodities within the recommended lead time was below average across most states (71%). States with a higher percentage of health workers who were aware of and placed orders following the national reporting timeline and those that delivered commodities to the last mile predominantly through third-party logistics service providers tended to have higher availability of mRDTs and artemether/lumefantrine combinations. The top 2 logistics challenges were insecurity and inadequate funding.
CONCLUSION
The availability of lifesaving malaria commodities across the health facilities visited was suboptimal, possibly due to several SCM challenges. The results from this study underscore the urgent need to implement effective interventions to address the observed gaps. This will contribute to reducing malaria morbidity and mortality among children aged younger than 5 years in Nigeria.
Topics: Humans; Nigeria; Malaria; Cross-Sectional Studies; Antimalarials; Child, Preschool; Public Sector; Artemisinins; Infant; Health Services Accessibility; Health Facilities; Surveys and Questionnaires
PubMed: 38871381
DOI: 10.9745/GHSP-D-22-00547 -
PloS One 2024Obesity and physical inactivity among children and young people are public health concerns. Despite the wide variety of interventions available to promote physical...
BACKGROUND
Obesity and physical inactivity among children and young people are public health concerns. Despite the wide variety of interventions available to promote physical activity, little is known about which interventions are most effective. This review aimed to evaluate the existing literature on school-based interventions that aim to increase physical activity among children and young people aged 6 to 18 years.
METHODS
A systematic review of reviews was undertaken. We searched for systematic reviews and meta-analyses published between December 2017 and January 2024 using databases such as PubMed, Scopus, and CINAHL. Titles and abstracts were independently screened by two reviewers, who also conducted data extraction and quality assessments. We focused on outcomes like changes in physical activity levels and body mass index to assess the effectiveness of the interventions.
RESULTS
A total of 23 reviews examining school-based physical activity interventions met the inclusion criteria, comprising 15 systematic reviews and 8 meta-analyses. All reviews (N = 23) were implemented in the school setting: three in primary schools, seven in secondary schools, and thirteen targeted both primary and secondary schools. The findings demonstrated that six reviews reported a statistical increase in physical activity levels among the target population, and one review found a decrease in body mass index. The most promising interventions focused on physical activity included within the school curriculum and were characterised as long-term interventions. 20 out of 23 reviews assessed the quality of primary studies.
CONCLUSION
Some interventions were promising in promoting physical activity among school-aged children and young people such as Daily Mile, Active Break, and Active transport while multi-component interventions seem to be positively effective in reducing BMI. Future efforts should focus on long-term, theory-driven programmes to ensure sustainable increases in physical activity.
Topics: Humans; Exercise; Child; Adolescent; Schools; Health Promotion; Body Mass Index; School Health Services
PubMed: 38870155
DOI: 10.1371/journal.pone.0304513 -
Cortex; a Journal Devoted To the Study... Jun 2024Understanding the neural substrate of altered conscious states is an important cultural, scientific, and clinical endeavour. Although hypnosis causes strong shifts in...
Understanding the neural substrate of altered conscious states is an important cultural, scientific, and clinical endeavour. Although hypnosis causes strong shifts in conscious perception and cognition, it remains largely unclear how hypnosis affects information processing in cortical networks. Here we manipulated the depth of hypnotic states to study information processing between cortical regions involved in attention and awareness. We used high-density Electroencephalography (EEG) to record resting-state cortical activity from 30 hypnosis experts during two hypnotic states with different depth. Each participant entered a light and a deep hypnotic state as well as two well-matched control states. Bridging top-down and lateralisation models of hypnosis, we found that interhemispheric frontoparietal connectivity distinguished hypnosis and control conditions, while no difference was found between the two hypnotic states. Using a graph-theoretic measure, we revealed that the amount of information passing through individual nodes (measured via betweenness centrality) is reduced during hypnosis relative to control states. Finally, we found that theta power was enhanced during hypnosis. Our result contributes to the current discussion around a role for theta power in bringing about hypnotic states, as well as other altered conscious states. Overall, our findings support the notion that altered top-down control in frontoparietal regions facilitates hypnosis by integrating information between cortical hemispheres.
PubMed: 38865762
DOI: 10.1016/j.cortex.2024.05.008 -
Microbiology Spectrum Jul 2024Since 1999, doxycycline and hydroxychloroquine have been the recommended treatment for chronic Q fever, a life-threatening disease caused by the bacterial pathogen, ....
UNLABELLED
Since 1999, doxycycline and hydroxychloroquine have been the recommended treatment for chronic Q fever, a life-threatening disease caused by the bacterial pathogen, . Despite the duration of its use, the treatment is not ideal due to the lengthy treatment time, high mortality rate, resistant strains, and the potential for contraindicated usage. A literature search was conducted to identify studies that screened large panels of drugs against to identify novel targets with potential efficacy against . Twelve candidate antimicrobials approved for use in humans by the US Food and Drug Administration were selected and minimum inhibitory concentrations (MICs) were determined against the low virulence strain Nine Mile phase II. Rifabutin and rifaximin were the best performing antibiotics tested with MICs of ≤0.01 µg mL. Further screening of these top candidates was conducted alongside two drugs from the same class, rifampin, well-characterized and rifapentine, not previously reported against . These were screened against virulent strains of representing three clinically relevant genotypes. Rifapentine was the most effective in the human monocytic leukemia cell line, THP-1, with a MIC ≤0.01 µg mL. In the human kidney epithelial cell line, A-498, efficacy of rifapentine, rifampin, and rifabutin varied across strains with MICs between ≤0.001 and 0.01 µg mL. Rifampin, rifabutin, and rifapentine were all bactericidal against ; however, rifabutin and rifapentine demonstrated impressive bactericidal activity as low as 0.1 µg mL and should be further explored as alternative Q fever treatments given their efficacy .
IMPORTANCE
This work will help inform investigators and physicians about potential alternative antimicrobial therapies targeting the causative agent of Q fever, . Chronic Q fever is difficult to treat, and alternative antimicrobials are needed. This manuscript explores the efficacy of rifamycin antibiotics against virulent strains of representing three clinically relevant genotypes . Importantly, this study determines the susceptibility of to rifapentine, which has not been previously reported. Evaluation of the bactericidal activity of the rifamycins reveals that rifabutin and rifapentine are bactericidal at low concentrations, which is unusual for antibiotics against .
Topics: Humans; Rifampin; Microbial Sensitivity Tests; Anti-Bacterial Agents; Coxiella burnetii; Rifamycins; Q Fever; Rifabutin; Cell Line
PubMed: 38864598
DOI: 10.1128/spectrum.01034-24