Objectives
To compare the degree of agreement of sonographic optic nerve sheath diameter (ONSD) measurements by ultrasound fellowship–trained and resident emergency medicine (EM) physicians.
Methods
...Ten ultrasound fellowship–trained EM attending physicians from multiple institutions and 51 resident EM physicians at a single residency were enrolled to measure the ONSD using a computerized ruler on five separate still‐frame sonograms of adult eyes that included the retrobulbar optic nerve. Descriptive and bivariate statistics for each ultrasound image were calculated to compare median ONSD measurements among groups. Intraclass correlation coefficients (ICCs) were calculated to estimate the inter‐rater reliability.
Results
Although the median ONSD measurement of each image did not significantly differ between resident and ultrasound fellowship–trained EM physicians, we found greater variation in agreement of ONSD measurements by resident EM physicians (ICC 0.50; 95% confidence interval 0.25–0.89) than ultrasound fellowship–trained EM physicians (ICC 0.73; 95% confidence interval 0.44–0.96).
Conclusions
Although both resident and ultrasound fellowship–trained EM physicians showed good inter‐rater reliability of ONSD measurements, variation in agreement among ultrasound fellowship–trained EM physicians may be as wide as 0.44, suggesting that even in skilled hands, ultrasound measurement of the ONSD may not be as dependable a screening tool for elevated intracranial pressure as previously suggested in the literature.
Dengue virus affects approximately 130 countries. Twenty‐five percentage of infections result in febrile, self‐limiting illness; heterotypic infection results in potentially fatal dengue haemorrhagic ...fever or dengue shock syndrome. Only one vaccine is currently available. Its efficacy is very variable. Thus, to target dengue, we used an innovative immunoinformatics protocol to design a putative epitope ensemble vaccine by selecting an optimal set of highly conserved epitopes with experimentally verified immunogenicity. From 1597 CD4+ and MHC II epitopes, six MHC Class I epitopes (RAVHADMGYW, GPWHLGKLEM, GLYGNGVVTK, NMIIMDEAHF, KTWAYHGSY and WAYHGSYEV) and nine MHC Class II epitopes (LAKAIFKLTYQNKVV, GKIVGLYGNGVVTTS, AAIFMTATPPGSVEA, AAIFMTATPPGTADA, GKTVWFVPSIKAGND, KFWNTTIAVSMANIF, RAIWYMWLGARYLEF, VGTYGLNTFTNMEVQ and WTLMYFHRRDLRLAA) were selected; this candidate vaccine achieved a world population coverage of 92.49%.
To target dengue, we used an innovative immunoinformatics protocol to design a putative epitope ensemble vaccine by selecting an optimal set of highly conserved epitopes with experimentally verified immunogenicity. Six MHC Class I epitopes (RAVHADMGYW, GPWHLGKLEM, GLYGNGVVTK, NMIIMDEAHF, KTWAYHGSY and WAYHGSYEV) and nine MHC Class II epitopes (LAKAIFKLTYQNKVV, GKIVGLYGNGVVTTS, AAIFMTATPPGSVEA, AAIFMTATPPGTADA, GKTVWFVPSIKAGND, KFWNTTIAVSMANIF, RAIWYMWLGARYLEF, VGTYGLNTFTNMEVQ and WTLMYFHRRDLRLAA) were selected. Our candidate vaccine achieved a world population coverage of 92.49%.
It is more than 20 years since the death of one of the most influential American clinical psychologists of the 20th century, Carl Rogers, who founded the client-centered school more than 50 years ...ago. Client-centered psychology remains a distinctive and alternative approach because of its assertion that the organismic valuing process is the engine of therapeutic change and the attendant implications for nondirective practice. Many of its ideas are also firmly integrated into other newer forms of therapy that acknowledge the person-centered approach as the foundation stone on which they were built. But less well understood is that many of the core ideas associated with person-centered psychology—such as its focus on therapeutic relationships, intrinsic motivation, and human potential—are topics that are alive and well in contemporary mainstream psychology. The aim is to promote bridge building among the person-centered community to these other areas of psychology.
Background
Individuals of advanced age with comorbidities face a higher risk of death from coronavirus disease 2019 (COVID‐19), especially once they are ventilator‐dependent. Respiratory decline in ...patients with COVID‐19 is precipitated by a lung‐mediated aberrant immune cytokine storm. Low‐dose lung radiation was used to treat pneumonia in the pre‐antibiotic era. Radiation immunomodulatory effects may improve outcomes for select patients with COVID‐19.
Methods
A single‐institution trial evaluating the safety and efficacy of single‐fraction, low‐dose whole‐lung radiation for patients with COVID‐19 pneumonia is being performed for the first time. This report describes outcomes of a planned day 7 interim analysis. Eligible patients were hospitalized, had radiographic consolidation, required supplemental oxygen, and were clinically deteriorating.
Results
Of 9 patients screened, 5 were treated with whole‐lung radiation on April 24 until April 28 2020, and they were followed for a minimum of 7 days. The median age was 90 years (range, 64‐94 years), and 4 were nursing home residents with multiple comorbidities. Within 24 hours of radiation, 3 patients (60%) were weaned from supplemental oxygen to ambient air, 4 (80%) exhibited radiographic improvement, and the median Glasgow Coma Scale score improved from 10 to 14. A fourth patient (80% overall recovery) was weaned from oxygen at hour 96. The mean time to clinical recovery was 35 hours. There were no acute toxicities.
Conclusions
In a pilot trial of 5 oxygen‐dependent elderly patients with COVID‐19 pneumonia, low‐dose whole‐lung radiation led to rapid improvements in clinical status, encephalopathy, and radiographic consolidation without acute toxicity. Low‐dose whole‐lung radiation appears to be safe, shows early promise of efficacy, and warrants further study.
Lay Summary
Researchers at Emory University report preliminary safety outcomes for patients treated with low‐dose lung irradiation for coronavirus disease 2019 (COVID‐19) pneumonia.
Five residents of nursing or group homes were hospitalized after testing positive for COVID‐19. Each had pneumonia visible on a chest x‐ray, required supplemental oxygen, and experienced a clinical decline in mental status or in work of breathing or a prolonged or escalating supplemental oxygen requirement.
A single treatment of low‐dose (1.5‐Gy) radiation to both lungs was delivered over the course of 10 to 15 minutes. There was no acute toxicity attributable to radiation therapy. Within 24 hours, 4 patients had rapidly improved breathing, and they recovered to room air at an average of 1.5 days (range, 3‐96 hours). Three were discharged at a mean time of 12 days, and 1 was preparing for discharge.
Blood tests and repeat imaging confirm that low‐dose whole‐lung radiation treatment appears safe for COVID‐19 pneumonia. Further trials are warranted.
In 5 elderly, oxygen‐dependent, and clinically declining nursing home residents with coronavirus disease 2019 (COVID‐19), low‐dose whole‐lung radiation has led to rapid clinical recovery and improvement in encephalopathy in an average of 24 to 36 hours, radiographic improvement by day 7, and hospital discharge an average of 12 days later—all without any acute toxicity. Low‐dose whole‐lung radiation appears to be safe, shows early signs of efficacy in COVID‐19, and warrants further study.
The effect of emotional stress on the spontaneous baroreceptor reflex (sBRR) in freely moving rats was investigated. Six male Wistar rats equipped with an intra-arterial polyethylene catheter were ...exposed to a 2-min air-jet stress. For time course analysis of the sBRR response to stress, the records of systolic blood pressure (SBP) and pulse interval (PI) were divided into five regions: baseline (BASELINE), acute exposure to air-jet stress (STRESS), immediate recovery (IMMED. RECOVERY), remaining recovery (RECOVERY), and delayed response (DELAYED RESPONSE). In addition to sBRR sensitivity and effectiveness, we introduce the sequence coverage area and its median for evaluation of the sBRR operating range and set point. During exposure to STRESS and IMMED. RECOVERY, sBRR sensitivity was preserved, its effectiveness was decreased, its operating range was enlarged, and the set point was shifted towards higher SBP and lower PI values. According to the joint symbolic dynamics analysis, the SBP and PI relationship became less predictable hence more prone to respond to stress. In RECOVERY the parameters regained baseline values and DELAYED RESPONSE occurred during which re-setting of sBRR was noted. It follows that emotional stress modulates sBRR differentially during the time course of stress and recovery, affecting both linearity and unpredictability of the BP and PI relationship.
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