Wastewater-based epidemiology is an emerging tool for tracking the spread of SARS-CoV-2 through populations. However, many factors influence recovery and quantification of SARS-CoV-2 from wastewater, ...complicating data interpretation. Specifically, these factors may differentially affect the measured virus concentration, depending on the laboratory methods used to perform the test. Many laboratories add a proxy virus to wastewater samples to determine losses associated with concentration and extraction of viral RNA. While measuring recovery of a proxy virus is an important process control, in this piece, we describe the caveats and limitations to the interpretation of this control, including that it typically does not account for losses during RNA extraction. We recommend reporting the directly measured concentration data alongside the measured recovery efficiency, rather than attempting to correct the concentration for recovery efficiency. Even though the ability to directly compare SARS-CoV-2 concentrations from different sampling locations determined using different methods is limited, concentration data (uncorrected for recovery) can be useful for public health response.
A mild traumatic brain injury (mTBI) is a complex pathophysiologic process that has a systemic effect on the body aside from solely an impairment in cognitive function. Dysfunction of the autonomic ...nervous system (ANS) has been found to induce abnormalities in organ systems throughout the body, and may contribute to cardiovascular dysregulation and increased mortality. Autonomic dysfunction, also known as dysautonomia, has been studied in moderate and severe TBI, and has emerged as a major contributing factor in the symptomatology in mTBI as well. Analysis of the ANS has been studied through changes in heart rate variability (HRV), pupillary dynamics, eye pressure, and arterial pulse wave in those with mild TBI. Graded exercise testing has been studied as both a method of diagnosis and as a means of recovery in those with mild TBI, especially in those with persistent symptoms. Given the studies showing persistence of autonomic dysfunction after symptomatic resolution of concussions, further research is needed to establish return to play protocols.
Summary
Background
Many therapeutic drugs are used by patients with inflammatory bowel disease, often around the time of conception. The pregnancy outcomes of males and females exposed to these ...therapeutics needs to be examined and this information is necessary to counsel patients appropriately.
Aim
To review the literature describing male infertility and inflammatory bowel disease to educate practitioners of the impact of inflammatory bowel disease on male reproduction and the impact of therapeutics on pregnancy outcomes.
Methods
We performed a PubMed search using the search terms ‘male infertility,’ ‘Crohn's disease,’ ‘inflammatory bowel disease,’ ‘ulcerative colitis,’ ‘ciprofloxacin AND infertility,’ ‘metronidazole AND infertility,’ ‘sulfasalazine AND infertility,’ ‘azathioprine AND infertility,’ ‘methotrexate AND infertility,’ ‘ciclosporin AND infertility,’ ‘corticosteroids AND infertility,’ ‘infliximab AND male fertility,’ ‘infliximab AND infertility,’ ‘infliximab AND foetus,’ ‘infliximab AND paternal exposure’ and ‘infliximab AND sperm.’ References from selected papers were reviewed and used if relevant.
Results
Over half of male patients with IBD have some degree of infertility, compared to 8–17% of the general population. Semen parameters including total count, motility and morphology may be adversely affected by therapeutics. IBD medications in males do not increase foetal risk with the possible exception of azathioprine and mercaptopurine; however, increased foetal risk is seen in other drugs if taken by female patients.
Conclusions
It is recognised that male infertility is often impacted with therapeutic drugs used to treat inflammatory bowel disease; however, the effects of the paternal drug exposure at the time of conception and exposure in utero should be considered to counsel patients appropriately.
Research on traumatic brain injury (TBI) as a result of domestic violence has greatly increased in the past decade, with publications addressing the prevalence, diagnosis, evaluation, and treatment. ...Although TBI due to domestic violence has recently been found to occur quite frequently, it was not widely understood until the 1990s. Individuals who suffer from domestic violence TBI often experience sequelae such as decreased cognitive functioning, memory loss, and PTSD. The goal of this article is to increase awareness about TBI secondary to domestic violence, with the intent that it will highlight areas for future research on the diagnosis, evaluation, and treatment of TBI in this population. The articles in this study were first found using the search terms traumatic brain injury and domestic violence. Although, in recent years, there has been a significant increase in research on TBI due to domestic violence, the overall conclusion of this review article is that there is still a need for future research in many areas including the effects on minority populations, the effects of COVID-19, and improvements of screening tools.
Background and Aims Liquid nitrogen spray cryotherapy (LNSCT) has been shown to be a safe, well-tolerated, and effective therapy for Barrett’s esophagus (BE)–associated high-grade dysplasia (BE-HGD) ...and intramucosal adenocarcinoma (IMC). Long-term follow-up is lacking. Aims The aim of this study was to assess the efficacy, durability, and rate of neoplastic progression after LNSCT in BE-HGD/IMC at 3 and 5 years. Methods In this single-center, retrospective study drawn from a prospective database, patients with BE-HGD/IMC of any length treated with LNSCT were followed with surveillance endoscopy with biopsy for 3 to 5 years. Patients with IMC completely removed by endoscopic resection were included. Outcome measures included complete eradication of HGD (CE-HGD), dysplasia, and intestinal metaplasia; incidence rates; durability of response; location of recurrent intestinal metaplasia and dysplasia; and rate of disease progression. Results A total of 50 and 40 patients were included in 3-year and 5-year analyses. Initial CE-HGD, dysplasia, and intestinal metaplasia achieved in 98%, 90%, and 60%, respectively. Overall CE-HGD, dysplasia, and intestinal metaplasia at 3 years were 96% (48/50), 94% (47/50), and 82% (41/50), and at 5 years were 93% (37/40), 88% (35/40), and 75% (30/40). Incidence rates of recurrent intestinal metaplasia, dysplasia, and HGD/esophageal adenocarcinoma per person-year of follow-up after initial complete eradication of intestinal metaplasia (CE-IM) were 12.2%, 4.0%, and 1.4% per person-year for the 5-year cohort. Most recurrences were found immediately below the neosquamocolumnar junction. Two of 7 HGD recurrences occurred later than 4 years after initial eradication, and 2 patients (4%) progressed to adenocarcinoma despite treatment. Conclusions In patients with BE-HGD/IMC, LNSCT is effective in eliminating dysplasia and intestinal metaplasia. Progression to adenocarcinoma was uncommon, and recurrence of dysplasia was successfully treated in most cases. Long-term surveillance is necessary to detect late recurrence of dysplasia.
We estimated excess mortality in Medicare recipients in the United States with probable and confirmed Covid-19 infections in the general community and amongst residents of long-term care (LTC) ...facilities. We considered 28,389,098 Medicare and dual-eligible recipients from one year before February 29, 2020 through September 30, 2020, with mortality followed through November 30th, 2020. Probable and confirmed Covid-19 diagnoses, presumably mostly symptomatic, were determined from ICD-10 codes. We developed a Risk Stratification Index (RSI) mortality model which was applied prospectively to establish baseline mortality risk. Excess deaths attributable to Covid-19 were estimated by comparing actual-to-expected deaths based on historical (2017-2019) comparisons and in closely matched concurrent (2020) cohorts with and without Covid-19. Overall, 677,100 (2.4%) beneficiaries had confirmed Covid-19 and 2,917,604 (10.3%) had probable Covid-19. A total of 472,329 confirmed cases were community living and 204,771 were in LTC. Mortality following a probable or confirmed diagnosis in the community increased from an expected incidence of about 4.0% to actual incidence of 7.5%. In long-term care facilities, the corresponding increase was from 20.3% to 24.6%. The absolute increase was therefore similar at 3-4% in the community and in LTC residents. The percentage increase was far greater in the community (89.5%) than among patients in chronic care facilities (21.1%) who had higher baseline risk of mortality. The LTC population without probable or confirmed Covid-19 diagnoses experienced 38,932 excess deaths (34.8%) compared to historical estimates. Limitations in access to Covid-19 testing and disease under-reporting in LTC patients probably were important factors, although social isolation and disruption in usual care presumably also contributed. Remarkably, there were 31,360 (5.4%) fewer deaths than expected in community dwellers without probable or confirmed Covid-19 diagnoses. Disruptions to the healthcare system and avoided medical care were thus apparently offset by other factors, representing overall benefit. The Covid-19 pandemic had marked effects on mortality, but the effects were highly context-dependent.
Over 6 million esophagogastroduodenoscopy (EGD) procedures are performed in the United States each year. Patients having anesthesia for advanced EGD procedures, such as interventional procedures, are ...at high risk for hypoxemia.
Our primary study aim was to evaluate whether high-flow nasal cannula (HFNC) oxygen reduces the incidence of hypoxemia during anesthesia for advanced EGD. Secondarily, we studied whether HFNC oxygen reduces hypercarbia or hypotension. After obtaining written informed consent, adults having anesthesia for advanced EGD, expected to last longer than 15 minutes, were randomly assigned to receive HFNC oxygen or standard nasal cannula (SNC) oxygen. The primary outcome was occurrence of one or more hypoxemia events during anesthesia, defined by arterial oxygen saturation <92% for at least 15 consecutive seconds. Secondary outcomes were occurrence of one or more hypercarbia or hypotension events. A hypercarbia event was defined by a transcutaneous CO2 measurement 20 mm Hg or more above baseline, and a hypotension event was defined by a mean arterial blood pressure measurement 25% or more below baseline.
Two hundred seventy-one adult patients were enrolled and randomized, and 262 patients completed study procedures. Eight randomized patients did not complete study procedures due to changes in their anesthesia or endoscopy plan. One patient was excluded from analysis because their procedure was aborted after 1 minute. Patients who received HFNC oxygen (N = 132) had a significantly lower incidence of hypoxemia than those who received SNC oxygen (N = 130; 21.2% vs 33.1%; hazard ratio HR = 0.59 95% confidence interval {CI}, 0.36-0.95; P = .03). There was no difference in the incidence of hypercarbia or hypotension between the groups. The HR for hypercarbia with HFNC oxygen was 1.29 (95% CI, 0.89-1.88; P = .17), and the HR for hypotension was 1.25 (95% CI, 0.86-1.82; P = .25).
HFNC oxygen reduces the incidence of hypoxemia during anesthesia for advanced EGD and may offer an opportunity to enhance patient safety during these procedures.
Partial-wave analysis is an important tool for analyzing large data sets in hadronic decays of light and heavy mesons. It commonly relies on the isobar model, which assumes multihadron final states ...originate from successive two-body decays of well-known undisturbed intermediate states. Recently, analyses of heavy-meson decays and diffractively produced states have attempted to overcome the strong model dependences of the isobar model. These analyses have overlooked that model-independent, or freed-isobar, partial-wave analysis can introduce mathematical ambiguities in results. We show how these ambiguities arise and present general techniques for identifying their presence and for correcting for them. We demonstrate these techniques with specific examples in both heavy-meson decay and pion–proton scattering.
A correlation between deep anesthesia (defined as time with Bispectral Index (BIS) <45; T(BIS <45)) and death within 1 yr after surgery has previously been reported. In order to confirm or refute ...these findings, we evaluated T(BIS <45) as an independent risk factor for death within 1 and 2 yr after surgery and also the impact of malignancy, the predominant cause of death in the previous report.
Mortality within 2 yr after surgery, causes of death and the occurrence of malignant disease at the time of surgery were identified in a cohort of 4087 BIS-monitored patients. Statistically significant univariate predictors of mortality were identified. In order to allow for comparison with previous data, the following multivariate analysis was first done without, and thereafter with, preexisting malignancy status, the predominant cause of death.
One-hundred-seventy-four (4.3%) patients died within 1 yr and another 92 during the second year (totaling 6.5% in 2 yr). T(BIS <45) was a significant predictor of 1- and 2-yr mortality when preexisting malignant disease was not among the co-variates (hazard ratio HR 1.13 1.01-1.27 and 1.18 1.08-1.29, respectively). Further exploration confined the significant relation between postoperative mortality and T(BIS <45) to patients with preexisting malignant diagnoses associated with extensive surgery and less favorable prognosis. The most powerful predictors of 2-yr mortality in the model, including preexisting malignancy, were ASA physical score class IV (HR 19.3 7.31-51.1), age >80 yr (HR 2.93 1.79-4.79), and preexisting malignancy associated with less favorable prognosis (HR 9.30 6.60-13.1).When the initial multivariate regression was repeated using preexisting malignancy status among the co-variates in the model, the previously significant relation between 1, and 2-yr mortality and T(BIS <45) did not reach statistical significance.
Using a similar set of co-variates as in previous work, we confirmed the statistical relation between 1-yr mortality and T(BIS <45), and we extended this observation to 2-yr mortality. However, this relation is sensitive to the selection of co-variates in the statistical model, and a randomized study is required to demonstrate that there really is a causal impact from and T(BIS <45) on postoperative mortality and, if it does, the effect is probably very weak in comparison with co-morbidity as assessed by ASA physical score, the preexisting malignancy status at surgery and age.
Recovery criteria under the Endangered Species Act are the objective, measurable targets for determining whether the recovery of listed species has been achieved. Existing criteria have been ...criticized as inconsistent and poorly supported. Recent proposals for improving those criteria have recommended framing them around population viability analysis (PVA) and setting criteria on the basis of extinction risk thresholds. Used in isolation, however, a PVA-centered approach is prone to limiting the scope of recovery, is too data intensive to be useful for most species, and risks misrepresenting normative recovery thresholds as objective. We recommend a framework based on the three Rs—the ecological principles of representation, resiliency, and redundancy—which makes use of multiple analytical approaches for setting recovery targets, including PVA when appropriate. We argue that the three Rs framework better fulfills the ESA’s comprehensive recovery mandates for achieving geographic representation, ecosystem conservation, and threats abatement while overcoming data and budget limitations pervasive in recovery planning today.
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