Outcomes and Clinical Characteristics of COVID-19 in Patients with Tuberculosis: A Retrospective Matched Cohort Study

The outcomes and characteristics of acute coronavirus disease 2019 (COVID-19) infection in patients with tuberculosis (TB) represent an evolving area of literature. This retrospective cohort study (March 2020–January 2021) within a large United States health system evaluated clinical and demographic characteristics, illness severity, complications, and mortality associated with acute COVID-19 infection in patients with TB (n = 31) compared to a matched (1:3) COVID-19 cohort without TB (n = 93). In the COVID-19 + TB cohort, TB was active in 32% and latent in 65% of patients, most patients (55%) had pulmonary TB, and 68% had previously undergone treatment for their TB. Patients with COVID-19 + TB infection had higher rates of hospitalization (45% vs. 36%, p = 0.34), intensive care unit (ICU) stay (16% vs. 8%, p = 0.16), and need for mechanical ventilation (13% vs. 3% p = 0.06). Discordant with those higher rates of markers typically denoting more severe illness, TB patients with acute COVID-19 did not have longer length-of-stay (5.0 vs. 6.1 days, p = 0.97), in-hospital mortality (3.2% vs. 3.2%, p = 1.00), or 30-day mortality (6.5% vs. 4.3%, p = 0.63). This study, while having limitations for extrapolation, cautions the notion that patients with COVID-19 and TB infers worse outcomes and adds to the growing body of literature on the interaction between these two infections.

Beyond the individual: Sexual minority help-seeking and the consequences of structural barriers

Sexual minorities report more psychological distress, unmet mental health needs, and barriers to mental health care compared with heterosexuals, yet little is known about their barriers to seeking out mental health care. The present study reports the factors that influence intentions to seek out mental health care of a national survey of 398 sexual minorities. Structural equation modeling identified structural barriers, such as cost, time, and knowing how to access services, as the strongest predictor of sexual minorities' help-seeking intentions. Latent moderators indicated sexual minorities' help-seeking intentions varied depending upon their degree of psychological distress. This revealed a pattern where the most vulnerable participants (i.e., those with high structural barriers and negative help-seeking attitudes) were willing to pursue mental health care only when they were experiencing significant distress. Furthermore, nearly 40% of participants reported unmet mental health needs, and structural barriers were the primary reasons for this deficit. Findings from this study contrast with previous mental health help-seeking research by emphasizing the importance of structural vulnerability, which refers to the external forces that frame and constrain choices, thereby impeding decision-making and limiting life options for those who are in systemically disadvantaged social positions. These findings are discussed in terms of counseling psychology training, practice, social justice advocacy, and future health care research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

International consensus conference recommendations on ultrasound education for undergraduate medical students

OBJECTIVES

The purpose of this study is to provide expert consensus recommendations to establish a global ultrasound curriculum for undergraduate medical students.

METHODS

64 multi-disciplinary ultrasound experts from 16 countries, 50 multi-disciplinary ultrasound consultants, and 21 medical students and residents contributed to these recommendations. A modified Delphi consensus method was used that included a systematic literature search, evaluation of the quality of literature by the GRADE system, and the RAND appropriateness method for panel judgment and consensus decisions. The process included four in-person international discussion sessions and two rounds of online voting.

RESULTS

A total of 332 consensus conference statements in four curricular domains were considered: (1) curricular scope (4 statements), (2) curricular rationale (10 statements), (3) curricular characteristics (14 statements), and (4) curricular content (304 statements). Of these 332 statements, 145 were recommended, 126 were strongly recommended, and 61 were not recommended. Important aspects of an undergraduate ultrasound curriculum identified include curricular integration across the basic and clinical sciences and a competency and entrustable professional activity-based model. The curriculum should form the foundation of a life-long continuum of ultrasound education that prepares students for advanced training and patient care. In addition, the curriculum should complement and support the medical school curriculum as a whole with enhanced understanding of anatomy, physiology, pathophysiological processes and clinical practice without displacing other important undergraduate learning. The content of the curriculum should be appropriate for the medical student level of training, evidence and expert opinion based, and include ongoing collaborative research and development to ensure optimum educational value and patient care.

CONCLUSIONS

The international consensus conference has provided the first comprehensive document of recommendations for a basic ultrasound curriculum. The document reflects the opinion of a diverse and representative group of international expert ultrasound practitioners, educators, and learners. These recommendations can standardize undergraduate medical student ultrasound education while serving as a basis for additional research in medical education and the application of ultrasound in clinical practice.

Applying the DSM-5 Alternative Model of Personality Disorders and the Shedler-Westen Assessment Procedure to the Classic Case of "Madeline G.": Novice and Expert Rater Convergences and Divergence

Prior research supports the learnability of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alternative Model of Personality Disorders (AMPD). However, researchers have yet to compare novice ratings on the AMPD's Level of Personality Functioning Scale and the 25 pathological personality traits with expert ratings. Furthermore, the AMPD has yet to be examined with the idiographic Shedler-Westen Assessment Procedure (SWAP). We compared the aggregated AMPD clinical profile of a group of psychology doctoral students who learned the AMPD to high levels of reliability to that of an expert rater using the crucible of the classical case of "Madeline G." Examination of AMPD and SWAP ratings of "Madeline G." revealed excellent overall concordance but suggests that novice raters tend to perceive lower levels of personality impairment.

Mycotic aortic aneurysm due to Capnocytophaga species infection treated non-surgically

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Capnocytophaga mycotic aneurysms are rare.

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Mycotic aneurysms are most often treated with surgical management.

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Immunocompromised and asplenic patients have greater suscepibility to Capnocytophagaa.

Capnocytophaga canimorsus, a commensal organism in canine flora, is most frequently transmitted to humans via animal bite. Infection can lead to multiorgan failure, disseminated intravascular coagulation, and uncommonly mycotic aneurysm. We present a case of a 65-year-old male who presented to the emergency department with right lower quadrant abdominal pain, nausea with vomiting, and diarrhea that began the evening prior to presentation. A computed tomography (CT) scan of the abdomen and pelvis with contrast demonstrated a 4.3 cm fusiform infrarenal aortic aneurysm concerning for a mycotic aneurysm. Vascular surgery felt there was a low likelihood of rupture and empiric antimicrobials were started. Eventually blood cultures grew a Capnocytophaga species and antimicrobials were then narrowed to imipenem. No surgical intervention was performed. Serial imaging showed stability of aneurysm with improvement and later complete resolution of inflammatory changes one month after onset of symptoms. This is the first reported case of Capnocytophaga mycotic aneurysm that was treated with antimicrobials alone and no surgical intervention.

Sexual Orientation Beliefs and Identity Development: A Person-Centered Analysis among Sexual Minorities

We conducted person-centered analysis of sexual orientation beliefs among sexual minorities to explore potential relationships between these beliefs and sexual orientation, developmental milestones, race and ethnicity, and attitudes about sexual orientation. We recruited participants (N = 416) via Amazon Mechanical Turk who completed measures of beliefs about sexual orientation and attitudes about their own sexuality, as well as assessments of mental health and age of sexual identity development milestones. We conducted a latent profile analysis and found three distinct sexual orientation belief profiles, similar to those previously observed in predominantly straight samples. We found that sexual orientation and race-ethnicity predicted belief profile membership, with the latter exhibiting the most substantial effect. Of the four identity developmental milestones tested, only the age of first same-sex attraction predicted belief profile membership. Across profiles, members differed significantly in their mean endorsement of both positive and negative attitudes regarding sexual orientation and psychological distress. Thus, the current research suggests that sexual orientation beliefs are powerful constructs in the lives of sexual minorities, with relationships to sexual orientation, other social identities, and mental health.

Contemporary Arterial Access in the Cardiac Catheterization Laboratory

Obtaining femoral and radial arterial access in the cardiac catheterization laboratory using state-of-the-art techniques is essential to optimize outcomes, patient satisfaction, and procedural efficiency. Although transradial access is increasingly used for coronary angiography and percutaneous coronary intervention, femoral access remains necessary for numerous procedures, many requiring large-bore access, including complex high-risk coronary interventions, structural procedures, and procedures involving mechanical circulatory support. For femoral access, contemporary access techniques should combine the use of fluoroscopy, ultrasound, micropuncture needle, femoral angiography, and vascular closure devices, when feasible. For radial access, ultrasound may reveal important anatomic features and expedite access. Despite randomized controlled trials supporting use of routine ultrasound guidance for femoral and/or radial arterial access, ultrasound remains underused in cardiac catheterization laboratories. This article reviews contemporary techniques to achieve optimal arterial access in the cardiac catheterization laboratory.

Copper-Mediated Trifluoromethylation of Benzylic Csp3 -H Bonds

Trifluoromethyl-containing compounds play a significant role in medicinal chemistry, materials and fine chemistry. Although direct C-H trifluoromethylation has been achieved on Csp² -H bonds, direct conversion of Csp³ -H bonds to Csp³ -CF₃ remains challenging. We report herein an efficient protocol for the selective trifluoromethylation of benzylic C-H bonds. This process is mediated by a combination Cu^III -CF₃ species and persulfate salts. A wide range of methylarenes can be selectively trifluoromethylated at the benzylic positions. A combination of experimental and theoretical mechanistic studies suggests that the reaction involves a radical intermediate and a Cu^III -CF₃ species as the CF₃ transfer reagent.

The mental health and psychosocial impact of the Bougainville Crisis: a synthesis of available information

Background

The Bougainville Crisis (1988–1997) was the largest armed conflict in the Pacific since WW-II. Despite this, there has been no assessment of the Mental Health and Psychosocial (MHPS) impact of the war. The aim of this paper is to summarize the available data regarding the longer-term MHPS impact of the Bougainville Crisis.

Methods

A literature review and a sequence of consultations in Bougainville were conducted to identify the MHPS impact of the Bougainville Crisis and the capacity within Bougainville to address these issues.

Results

The Bougainville Crisis resulted in violence-related deaths; the displacement of more than half of the population; widespread human rights abuses; far-reaching societal impacts including undermining of the traditional authority of elders and women and damage to cultural values and relationships; property damage; and significant impacts on education and the economy. Conflict-related experiences continue to impact on mental health in the form of trauma-related symptoms, anger, complicated grief, alcohol and substance abuse, domestic violence including sexual assault, excessive alcohol use and a lack of engagement in purposeful activities. Other impacts include an increase in other forms of gender-based violence (including sexual assault), population displacement, and adverse trans-generational effects on children exposed to disturbed parental behaviours attributable to conflict exposure. In spite of the evident needs, there is limited capacity within Bougainville to address these pressing MHPS issues.

Conclusions

The Bougainville Crisis has had a significant MHPS impact at multiple levels in the society. There is a strong interest within Bougainville to draw on external expertise to build local capacity to address MHPS issues. Preliminary recommendations are made to assist the process of building the capacity in Bougainville to address MHPS needs.

Real-time contrast-enhanced holographic imaging using phase coherent photorefractive quantum wells

We demonstrate wide-field real-time and depth-resolved contrast enhanced holographic imaging (CEHI) using the all-optical phase coherent photorefractive effect in ZnSe quantum wells. Moving objects are imaged at large depth-of-field by the local enhancement of a static reference hologram. The high refresh rate of the holographic films enables direct-to-video monitoring of floating glass beads and of living Paramecium and Euglena cells moving in water. Depth resolution is achieved by tilting the incident laser beam with respect to the normal of the cuvette. This creates double images of the objects, which are analyzed geometrically and with Fresnel diffraction theory. A two-color CEHI set-up further enables the visualization of a concealed 95 µm thick wire behind a thin layer of chicken skin.

Influenza and respiratory syncytial virus detection in clinical specimens without nucleic acid extraction using FOCUS direct disc assay is substantially equivalent to the traditional methods and the FOCUS nucleic acid extraction-dependent RT-PCR assay

In this study, we evaluated FOCUS diagnostic's Flu A/B & RSV direct kit (Direct Disc assay), designed to detect influenza (FLU) and respiratory syncytial viruses (RSV) directly in clinical specimens without nucleic acid extraction. This novel 'sample-to-answer', nucleic acid extraction-independent assay uses a unique disc to process, amplify, and detect viral targets in up to 8 specimens at a time. The performance of this assay for detecting FLU and RSV viruses was compared to the traditional methods (culture and/or direct florescent antibody testing) using 945 nasopharyngeal swab specimens. In addition, a total of 150 consecutive clinical specimens positive for FLU (FLU A=50, FLU B=50) or RSV (n=50) were tested in parallel using the novel Direct Disc assay and FOCUS diagnostic's nucleic acid extraction-dependent assay to assess their relative performance. Compared to the traditional methods, the overall (prospective+retrospective) positive/negative percent agreement was determined to be 96.6%/98.1% for FLU A, 98.4%/99.9% for FLU B, and 99.3%/98.8% for RSV. Compared to the nucleic acid extraction-dependent assay, the positive percent agreement was 90% (n=45/50) for FLU A, 92% (n=46/50) for FLU B, and 98% (n=49/50) for RSV. Overall, the Direct Disc assay showed good agreement with both traditional methods and nucleic acid extraction-dependent assay. Although we encountered some failures compared to the nucleic acid extraction-dependent assay, these limitations must be balanced against the substantial advantages of the extraction-free nature of this assay and rapid turnaround time.

Efficacy and safety of histrelin subdermal implant in children with central precocious puberty: a multicenter trial

CONTEXT

GnRH analog (GnRHa) therapy for central precocious puberty (CPP) typically involves im injections. The histrelin implant is a new treatment that provides a continuous slow release of the GnRHa histrelin.

OBJECTIVE

The objective of the study was to investigate the safety and efficacy of the subdermal histrelin implant for the treatment of CPP in treatment naive and previously treated children.

DESIGN

This was a phase III, open-label, prospective study of 1-yr duration.

SETTING

The study was conducted at nine U.S. medical centers.

PATIENTS

Girls ages 2-8 yr (naive) or 2-10 yr (previously treated) and boys 2-9 yr (naive) or 2-11 yr (previously treated) with clinical evidence of CPP and a pretreatment pubertal response to leuprolide stimulation were eligible.

INTERVENTION

A 50-mg histrelin implant was inserted sc in the inner upper arm.

MAIN OUTCOME MEASURES

Peak LH after GnRHa stimulation testing and estradiol (girls) and testosterone (boys) were the main outcome measures.

RESULTS

Thirty-six subjects (20 naive) were enrolled. By 1 month, peak LH fell from 28.2 +/- 19.97 (naive) to 0.8 +/- 0.39 mIU/ml (P < 0.0001) and from 2.1 +/- 2.15 (previously treated) to 0.5 +/- 0.32 mIU/ml (P < 0.0056). Estradiol suppressed from 24.5 +/- 22.27 (naive) to 5.9 +/- 2.37 pg/ml (P = 0.0016) and remained suppressed in previously treated subjects, as did testosterone. Suppression was maintained throughout the study. No significant adverse events occurred.

CONCLUSIONS

The subdermal histrelin implant achieves and maintains excellent suppression of peak LH and sex steroid levels for 1 yr in children with CPP. The treatment is well tolerated. Long-term studies are needed to confirm these results.

Electron spin resonance and raman scattering spectroscopy of multi-walled carbon nanotubes: a function of acid treatment

We compare the fundamental transport mechanism in multi-walled carbon nanotubes (MWNTs) by means of electron spin resonance (ESR) and Raman spectroscopy as a function of acid treatment. The ESR and Raman results show that the acid treatment reduces the density of states at the Fermi level. Defects introduced through the acid treatment move the Fermi level closer to the K points in the valence band, and consequently conduction is reduced. These defects are identified as Stone-Wales type from the Raman results.

Release of atrazine ((14)C) from two undisturbed submerged sediments over a two-year period

Through water erosion and runoff, sediment-adsorbed atrazine can undergo sedimentation and accumulation at the bottom of water bodies and become potential sources of atrazine to the water column. The purpose of this study is to determine the fate and release of atrazine ((14)C) to the water column from two simulated undisturbed submerged sediments at two temperature treatments (5 and 24 degrees C) over a 2-year period. Atrazine residue ((14)C) was released from the two sediments and was, primarily, diffusing from the sediment pore water to the water columns. The amount released was affected by sediment type and is related to the sediment's adsorption/desorption capacity. Larger amounts of residue ((14)C) were released to the water columns at 5 degrees C than at 24 degrees C. Atrazine degraded in the shallow submerged anaerobic sediment's water columns over the 2-year period. Less than 2% (percent of applied in atrazine equivalent) of extractable atrazine and metabolites remained in the sediment after 2 years. The amount of nonextractable atrazine residue ((1)(4)C) was significantly higher in sediments at 24 degrees C than at 5 degrees C. In conclusion, atrazine accumulating in shallow undisturbed submerged sediments from nonpoint sources would most likely degrade and/or become nonextractable over time and would have a low probability of becoming a significant source to the water body. The conditions where accumulation and future release of atrazine have a greater potential to occur are under very cold temperatures with low adsorption capacity sediments.

Two comparative endoscopic evaluations of Naprelan

This paper describes the results of two endoscopic studies of Naprelan (Wyeth-Ayerst Laboratories, Philadelphia, Pennsylvania), a controlled-release formulation of naproxen sodium. In one study, 19 healthy male subjects received either 2 controlled release Naprelan 500-mg tablets once daily or 1 Naprosyn (naproxen; Syntex Laboratories, Inc., Palo Alto, California) 500-mg tablet BID. At baseline, all subjects had gastroduodenal endoscopy scores of 0 on both the Lanza and Euler scales. Although the trend favored Naprelan, differences in Lanza and Euler scale elevations were not statistically significant. Eight of 10 subjects in the Naprelan group and 7 of 9 subjects in the Naprosyn group reported a total of 27 adverse events (AEs). In the second study, healthy subjects received Naprelan 1,000 mg once daily, Naprosyn 500 mg BID, and film-coated aspirin 650 mg QID. In the stomach, there was a significant difference in favor of Naprelan over aspirin (P = 0.0001) and in favor of Naprosyn over aspirin (P = 0.0001). Fewer erosions were seen in the duodenum than in the stomach. In the duodenum, there was a significant difference in favor of Naprelan over Naprosyn (P = 0.0236), and in favor of Naprelan over aspirin (P = 0.0086), but the difference between Naprosyn and aspirin was not significant (P = 0.6643). Of the 23 subjects who received medication, 12 reported AEs: 8 while receiving aspirin, 3 while receiving Naprosyn, and 1 while receiving Naprelan. Differences in the number of erosions and ulcers seen following each of the periods of drug administration favored Naprelan and the Intestinal Protective Drug Absorption System.

When is light work heavy? Components of the physical workload of sewing machine operators working at piecework rates

Epidemiologists have associated the job of sewing machine operators with a high incidence of musculoskeletal and other health problems, despite its classifications as light work according to energy expenditure criteria. An ergonomic analysis was undertaken in a trouser factory in order to describe components of the physical load of this work: force exerted, repetitions, time allocation and postures. Work activity of ten operators was observed and timed in situ, and forces were measured with a dynamometer. The time required to sew one seam is very short, 10-15 s per trouser leg. This short cycle is repeated more than 1500 times during the work day, involving quasi-continuous movements of the same parts of the body. The fact that movements are repeated so many times means that small details of the task assume a great importance. During the work day, a substantial force is exerted, only part of which can be measured with current technology. By these measurements, operators lift an average 406.1 kg of trousers per day and exert an average total force of 2858.4 kg with the upper limbs and 24 267.9 kg with the lower limbs. The work posture is static: seated with upper back curved and head bent over the sewing machine. Movements of the upper limbs involve abduction and adduction of the shoulders while exerting a force. For the same task, there is considerable variation in the dimensions of workstations. Interviews were conducted to determine the types of musculoskeletal complaints. The components of work activity could be treated to these complaints and to existing epidemiological data on musculoskeletal problems among sewing machine operators. This type of detailed examination can be applied by health and safety personnel to identify task components which could be changed to minimize the probability of musculoskeletal problems.

She ate not the bread of idleness: exhaustion is related to domestic and salaried working conditions among 539 Québec hospital workers

Hospital workers completed a questionnaire on domestic and professional working conditions and health symptoms. Workers were asked to estimate the number of domestic work hours, and the degree of sharing of laundry, cleaning, meal preparation and childcare. Responses from the 532 women workers showed an average professional work week of 31.2 hours and an average domestic work week of 19.2 hours. The length of the domestic work week increased with the number of children, and the degree of sharing diminished. Among couples with children, the reported length of the domestic work week correlated highly with an index calculated from the degree of sharing of domestic tasks, and the number and ages of children. Exhaustion and insomnia were associated with work speed and shift work, respectively, at the hospital job, but also with the number of hours of domestic work. Backache, which was related to lifting weights in the workplace, was not associated with the number of reported hours of domestic work. Due to errors in formulating some questions, the study underestimates total hours of domestic work, and, probably, effects of domestic work on health. However, it is the first North American study to show the combined effects of domestic work and paid work on physical health symptoms among women.

Delayed speech feedback and age

The effects of delayed speech feedback on errors and rate of reading in persons of different age were measured by an audiotape technique of producing side-tone ' delay. The age ranges studied were 0–8, 22–38, and 42–68. There were 18 subjects in each age range. A differential effect of the delay on the speech of the subjects of the three age ranges was found, with the older persons showing somewhat more marked disturbances of speech. The differences between age groups occurred primarily in the effects of the delay on frequency of errors and not on rate of speaking. This suggests that it was primarily the articulatory components of speech that were affected by feedback time distortion and by age.