COVID-19, I Hate You!": Framing Death and Dying in COVID-19 Online Memorials

The COVID-19 pandemic has reshaped the way Americans deal with death and dying. Social distancing restrictions prevented or delayed end of life services for families who lost loved ones to COVID-19. Alternatively, some took to the internet to express their grief through online memorialization. Using content analysis, this study analyzes 200 randomly selected online memorials from the COVID Memorial website, a website created to share the stories of those lost to COVID-19 on social media. Our findings offer insight into memorial author demographics, how memorial authors framed and understood death due to COVID-19, and the COVID-19 pandemic through online memorialization. Two major themes emerged during data analysis, "references to COVID-19 death" and "COVID-specific directives to readers." The  former, details how memorial authors framed and understood the death of a loved one to COVID-19. The latter details "advice" or "directives" authors gave to readers about social distancing guidelines and other guidelines meant to prevent the spread of COVID-19.

Anatomic Approach and Outcomes in Children Undergoing Percutaneous Pericardiocentesis

Pericardiocentesis is traditionally performed using a subxiphoid approach. Hepatomegaly or loculated and noncircumferential effusions warrant nonstandard approaches to drain effusions; echocardiographic guidance has made these less traditional, non-subxiphoid approaches feasible. The study is aimed at comparing clinical outcomes of the subxiphoid and non-subxiphoid approaches to percutaneous pericardiocentesis in a pediatric population. This is a retrospective chart review of all children undergoing percutaneous pericardiocentesis from August 2008 to December 2019 at a single-center. A total of 104 patients underwent echocardiography-guided pericardiocentesis during the timeframe. Additionally, fluoroscopy was also used in 80 patients. Hematopoietic stem cell transplantation was the most common underlying diagnosis (n = 53, 50.9%). A non-subxiphoid approach was used in 58.6% (n = 61) of patients. The fifth and sixth intercostal spaces were the most commonly used (n = 17 each). The non-subxiphoid group tended to be older (95.9 vs. 21.7 months, p = 0.006) and weighed more (23.6 vs. 11.2 kgs, p = 0.013) as compared to the subxiphoid group. Non-subxiphoid approach was associated with shorter procedure times (21 vs. 37 min, p = 0.005). No major complications were seen. Five minor complications occurred and were equally distributed in the two groups. Complications were more likely in younger patients (p = 0.047). The technique and anatomic approach to pericardiocentesis, and the location or size of effusion did not influence the risk of complications. Echocardiography-guided percutaneous pericardiocentesis in children was associated with low complication rates in this single-center pediatric experience. The use of a non-traditional, non-subxiphoid approach was associated with shorter procedure times and did not significantly affect complication rates.

Chest palpitations in a teenager as an unusual presentation of Lyme disease: case report

BACKGROUND

The incidence of Lyme disease (LD) in North America has increased substantially in the past two decades. Concomitant with the increased incidence of infection has been an enhancement in the recognition of LD complications. Here, we report a case of Lyme carditis complicated by heart block in a pediatric patient admitted to our children's hospital. What is unique about this case is that the complaint of chest palpitations is an infrequent presentation of LD, and what it adds to the scientific literature is an improved understanding of LD in the pediatric population.

CASE PRESENTATION

The patient was a 16-year-old male who presented with the main concerns of acute onset of palpitations and chest pain. An important clinical finding was Erythema migrans (EM) on physical exam. The primary diagnoses were LD with associated Lyme carditis, based on the finding of 1st degree atrioventricular heart block (AVB) and positive IgM and IgG antibodies to Borrelia burgdorferi. Interventions included echocardiography, electrocardiography (EKG), and intravenous antibiotics. The hospital course was further remarkable for transition to 2nd degree heart block and transient episodes of complete heart block. A normal sinus rhythm and PR interval were restored after antibiotic therapy and the primary outcome was that of an uneventful recovery.

CONCLUSIONS

Lyme carditis occurs in < 5% of LD cases, but the "take-away" lesson of this case is that carditis can be the presenting manifestation of B. burgdorferi infection in pediatric patients. Any patient with suspected Lyme carditis manifesting cardiac symptoms such as syncope, chest pain, or EKG changes should be admitted for parenteral antibiotic therapy and cardiac monitoring. The most common manifestation of Lyme carditis is AVB. AVB may manifest as first-degree block, or may present as high-grade second or third-degree block. Other manifestations of Lyme carditis may include myopericarditis, left ventricular dysfunction, and cardiomegaly. Resolution of carditis is typically achieved through antibiotic administration, although pacemaker placement should be considered if the PR interval fails to normalize or if higher degrees of heart block, with accompanying symptoms, are encountered. With the rising incidence of LD, providers must maintain a high level of suspicion in order to promptly diagnose and treat Lyme carditis.

Evaluation of mobile digital light-emitting diode fluorescence microscopy in Hanoi, Viet Nam

SETTING

Hanoi Lung Hospital, Hanoi, Viet Nam.

OBJECTIVE

To compare the accuracy of CellScopeTB, a manually operated mobile digital fluorescence microscope, with conventional microscopy techniques.

DESIGN

Patients referred for sputum smear microscopy to the Hanoi Lung Hospital from May to September 2013 were included. Ziehl-Neelsen (ZN) smear microscopy, conventional light-emitting diode (LED) fluorescence microscopy (FM), CellScopeTB-based LED FM and Xpert(®) MTB/RIF were performed on sputum samples. The sensitivity and specificity of microscopy techniques were determined in reference to Xpert results, and differences were compared using McNemar's paired test of proportions.

RESULTS

Of 326 patients enrolled, 93 (28.5%) were Xpert-positive for TB. The sensitivity of ZN microscopy, conventional LED FM, and CellScopeTB-based LED FM was respectively 37.6% (95%CI 27.8-48.3), 41.9% (95%CI 31.8-52.6), and 35.5% (95%CI 25.8-46.1). The sensitivity of CellScopeTB was similar to that of conventional LED FM (difference -6.5%, 95%CI -18.2 to 5.3, P = 0.33) and ZN microscopy (difference -2.2%, 95%CI -9.2 to 4.9, P = 0.73). The specificity was >99% for all three techniques.

DISCUSSION

CellScopeTB performed similarly to conventional microscopy techniques in the hands of experienced TB microscopists. However, the sensitivity of all sputum microscopy techniques was low. Options enabled by digital microscopy, such as automated imaging with real-time computerized analysis, should be explored to increase sensitivity.

Moving home: costs associated with different models of accommodation for adults with learning disabilities

This paper reports on variation in the cost and social outcomes of provision for clients with learning disabilities, resettled across different models of community accommodation; identifying personal and service-related characteristics influential on such variation. The study was conducted to inform the community reprovisioning strategy associated with the phased closure of the Gogarburn and Tornaveen learning disability hospitals in the Lothian region, Scotland. Total mean service costs, quality of life and community integration outcome data were collected and compared. Total mean service costs ranged between pound16 438 and pound74 097 per year (mean pound42 023; SD = pound16 712). Cost estimates varied by age and dependency group, with costs for elderly clients comparatively low. Overall, there was an inverse relationship between total mean costs and size of accommodation. There was no evidence of a direct relationship between costs and changes in social outcomes. Services with the lowest mean costs were, however, associated with the smallest increases in social outcomes. The most expensive services did not realise proportionally greater gains in social outcomes. The paper concludes that clients generally benefited from the transition from hospital to community accommodation. However, some experienced better outcomes than others. In the absence of a clear link between levels and type of resource use and social outcomes, it is difficult to identify which service features are more or less efficacious in achieving positive outcomes. Broader evaluation perspectives, embracing a fuller range of costs and benefits, will be required to unpack exactly what it is about different models of community care provision that leads to positive outcomes, or otherwise, for learning disability clients. A more sound evidence base is required before effective strategies can be designed to ensure that key policy outcomes are realised and social integration truly achieved.

Three-dimensional microscopy data exploration by interactive volume visualization

This paper presents a new volume visualization approach for three-dimensional (3-D) interactive microscopy data exploration. Because of their unique image characteristics, 3-D microscopy data are often not able to be visualized effectively by conventional volume visualization techniques. In our approach, microscopy visualization is carried out in an interactive data exploration environment, based on a combination of interactive volume rendering techniques and image-based transfer function design methods. Interactive volume rendering is achieved by using two-dimensional (2-D) texture mapping in a Shear-Warp volume rendering algorithm. Image processing techniques are employed and integrated into the rendering pipeline for the definition and searching of appropriate transfer functions that best reflect the user's visualization intentions. These techniques have been implemented successfully in a prototype visualization system on low-end and middle-range SGI desktop workstations. Since only 2-D texture mapping is required, the system can also be easily ported to PC platforms.

Subretinal fibrosis in diabetic macular edema. ETDRS report 23. Early Treatment Diabetic Retinopathy Study Research Group

OBJECTIVE

To describe the characteristics of and risk factors for subretinal fibrosis (SRF) in patients with diabetic macular edema.

PATIENTS AND METHODS

A total of 109 eyes (in 96 persons) with SRF, defined as a mound or sheet of gray to white tissue beneath the retina at or near the center of the macula, were identified during the Early Treatment Diabetic Retinopathy Study, which is a randomized clinical trial of photocoagulation and aspirin treatment in patients with mild to severe nonproliferative or early proliferative diabetic retinopathy. The patients and the ocular characteristics of these 109 eyes, all of which had clinically significant macular edema, were compared with those of 5653 eyes in which clinically significant macular edema, but not SRF, was observed during the trial.

RESULTS

In 9 of 109 eyes, the development of SRF may have been directly related to focal photocoagulation. Seventy-four percent of the eyes in which SRF developed had very severe hard exudates in the macula prior to the development of SRF, while this level of hard exudates was seen in only 2.5% of the eyes with clinically significant macular edema in which SRF did not develop (P < .001). Of the 264 eyes with this level of hard exudates at baseline (n = 29) or during follow-up (n = 235), SRF developed in 30.7% of the eyes, while this complication developed in only 0.05% of 5498 eyes with clinically significant macular edema without this level of hard exudates.

CONCLUSIONS

Subretinal fibrosis is an infrequent complication of diabetic macular edema. Although it has been reported to be associated with photocoagulation burn intensity, in only 9 of 109 eyes in which SRF developed was it located adjacent to a photocoagulation-related scar (among 4823 eyes that received focal photocoagulation for treatment of macular edema). The strongest risk factor for the development of SRF is very severe hard exudate.

Effects of blood alcohol concentrations on negative punishment: implications for decision making

OBJECTIVE

A series of studies examined how various blood ethanol concentrations influenced the effectiveness of a negative punishment procedure in a risk-taking/decision-making task. Based on the animal punishment literature plus the impression that ethanol diminishes the effects of punishment and impairs decision making, it was predicted that individuals receiving alcohol would increase their risk- taking behavior despite the presence of a negative punishment stimulus (point loss) given on a variable schedule.

METHODS

In Experiment 1, a within-subjects design with repeated measures was used where 10 male subjects played a modified computer-generated choice game under three levels of punishment certainty, three levels of punishment severity and four ranges of blood ethanol (0.00%, 0.01-0.049%, 0.050-0.099%, 0.10-0.15%)

RESULTS

Results indicated significant decreases in risk taking as either punishment certainty or severity was increased. However, no significant effects were found for ethanol, or interactions of ethanol with punishment certainty or punishment severity. Two additional studies examining aspects of the experimental procedure produced similar results

CONCLUSIONS

Overall, the results of these studies do not support the hypothesis that high concentrations of blood alcohol are sufficient in and of themselves to eliminate the suppression function of negative punishment contingencies leading to increased risk-taking behavior. The implications of these results for understanding blood alcohol effects are discussed.

Effects of season on electro-oculographic ratio in winter seasonal affective disorder

Low electro-oculographic (EOG) ratios have been reported in patients with seasonal affective disorder (SAD) during the winter. This study evaluated the effects of the changing seasons on EOG ratios in SAD patients. Sixteen outpatients with SAD and 16 age-, sex-, and medication-matched normal volunteers had EOG testing during the winter and again during the summer. There was a significant season x group interaction in EOG ratios, with normal subjects showing higher ratios in winter than in summer--a seasonal variation not observed in SAD patients. SAD patients may have a subsensitivity to environmental light that leads them to experience symptoms during the winter.

Choroidovitreal neovascular ingrowth after photocoagulation for proliferative diabetic retinopathy

In eight patients with proliferative diabetic retinopathy treated with focal photocoagulation for preretinal new vessels, recurrent preretinal new-vessel systems supplied from the choroid developed. Subsequent treatment in most cases failed to produce permanent obliteration of the new-vessels networks.

Pigmented paravenous retinochoroidal atrophy

A patient with paravenous pigmented chorioretinal atrophy is presented. A differential diagnosis and review of the literature are discussed. Fluorescein angiography confirms the presence of a widespread paravenous retinal pigment epithelial defect with minimally affected choroidal vasculature. The visual fields are constricted in proportion to the extent of the pigmentary abnormality. The electro-oculogram and electroretinogram show reduced responses indicative of a more extensive abnormality than is visible ophthalmoscopically. The etiology and natural course of this entity are unknown.