Masongibbons5048

In the context of the ongoing global outbreak of coronavirus disease 2019 (COVID-19), management of exposure events is a concern. Long-term care hospitals (LTCHs) are particularly vulnerable to cluster outbreaks because facilities for patient isolation and healthcare personnel to care for these patients in isolation are difficult to arrange in a large outbreak situation. Although several drugs have been proposed as treatment options, there are no data on the effectiveness and safety of post-exposure prophylaxis (PEP) for COVID-19. After a large COVID-19 exposure event in an LTCH in Korea, PEP using hydroxychloroquine (HCQ) was administered to 211 individuals, including 189 patients and 22 careworkers, whose baseline polymerase chain reaction (PCR) tests for COVID-19 were negative. PEP was completed in 184 (97.4%) patients and 21 (95.5%) careworkers without serious adverse events. At the end of 14 days of quarantine, all follow-up PCR tests were negative. Based on our experience, further clinical studies are recommended for COVID-19 PEP. A markedly increased demand for vascular ultrasound laboratory and other imaging studies in COVID-19 positive patients has occurred, due to most with markedly elevated D-dimer, and a presumed prothrombotic state in many of the very ill patients. This article summarizes a broad institutional consensus focusing on evaluation and recommended empirical therapy for COVID-19 positive patients. We recommend following the algorithms with the idea that as more data becomes available that this may well change. Permanent inferior vena cava (IVC) filters are used to prevent venous thromboembolic events (VTE) in select patient populations. The Bird's Nest Filter (BNF) is an IVC filter that has been associated with various complications including filter strut fractures, migration, caval wall perforation, visceral perforation, and vascular injury. We report a case of a BNF that eroded transmurally through the IVC into the right kidney parenchyma. The patient underwent operative intervention with removal of the BNF with an uncomplicated post-operative course. In patients with symptoms and local filter perforations, we advocate for safe filter removal when possible to avoid long term damage. Lymphatic malformations (LM) are rare congenital anomalies. LM are often refractory to standard treatments including surgical resection, debulking and sclerotherapy. Use of sildenafil, a phosphodiesterase-5 inhibitor (PDE-5i), for treatment of pediatric LM has been reported with demonstrated benefit to some patients. This case series reports treatment of three patients (ages 14-37 years) suffering from complicated or refractory LM with low dose oral PDE-5i resulting in significant clinical improvement. Despite national guidelines recommending daily fruit and vegetable (FV) consumption, intake of FV among adolescents is low. Over the past 10-15 years, state and federal laws have reduced the availability of junk foods in schools. This study examined the association between state snack laws and high school (HS) student FV consumption. The overall sample included 99,785 HS students (outcome samples ranged from 96,209-97,328) included in the Youth Risk Behavior Survey (YRBS). National Cancer Institute Classification of Laws Associated with School Students' data for 2004-2016 were lagged on to 2005-2017 YRBS data. Separate analyses examined the state law-youth FV consumption relationship pre- and post-federal Smart Snacks standards (effective school year 2014-2015). Analyses were conducted between 2018 and 2020. Overall, state laws were associated with any vegetable, salad, and other vegetable consumption. The relationship between state laws and vegetable consumption primarily occurred pre-Smart Snacks. Pre-Smart Snacks, state laws were associated with higher odds of youth consumption of any vegetable, salad, carrots, and other vegetables (all compared to students in states without snack laws). The only association post-Smart Snacks was between strong state laws and salads. This study illustrates the important role that standards restricting the availability of junk foods in schools can have on increasing student vegetable consumption. Given current efforts to roll-back federal school meal standards, findings from this study illustrate how federal standards harmonized the patchwork of state laws that existed prior to Smart Snacks and the important role that consistent national standards can play in supporting student consumption of vegetables. selleck After the school shooting at Marjory Stoneman Douglas High School in Parkland, Florida in 2018, there was an increase in gun violence prevention-related advocacy. While much of this recent political activity and engagement was led by young adults, little is known about support for specific gun policies within this age group. This study uses data from two nationally representative surveys fielded in 2017 and 2019 to compare public support for gun policies (1) between young adults age 18-29 years and adults age 30 and older, and (2) between young adults in 2017 and young adults in 2019, before and after the Parkland shooting. Relative to adults age 30 and older, young adults had lower support for 16 of 20 gun violence prevention policies examined. Public support was largely unchanged between 2017 and 2019 among survey respondents ages 18-29; however, support for requiring a safety test for concealed carry decreased significantly among young adults between 2017 and 2019. Despite owning fewer guns and finding gun violence prevention important generally, young adults appear to have lower support for policies that regulate guns compared to older adults. CONTEXT Anxiety in cancer patients is highly prevalent, yet remains underestimated and inadequately assessed. Little is known about predictors for anxiety in hospitalized cancer patients. Insight in predictors should improve recognition and enable a targeted approach. OBJECTIVES To determine the prevalence of anxiety and predictors for anxiety in hospitalized cancer patients, at different stages of disease. METHODS A cross-sectional analysis of cancer patients admitted to the Utrecht University Medical Centre in 2015-2018 was conducted. The Utrecht Symptom Diary, an adapted Dutch version of the Edmonton Symptom Assessment System, was used to assess symptom burden on a numeric rating scale (0=no symptom, 10=worst possible). Scores ≥4 were considered clinically relevant. All patients completed the USD as part of routine care. The first questionnaire after admission was selected. Using multivariable linear regression, the predictive value of potential predictors on anxiety was analyzed. RESULTS In total, 2144 pad for structural assessment and intensification of monitoring when predictors are present. CONTEXT The decision to request and proceed with euthanasia or physician-assisted dying (PAD) is complex, and predictors of such decisions are heterogeneous with regard to physical health, psychological, and social factors. Local research is therefore needed. OBJECTIVE To examine the interplay of demographic, clinical and psychosocial factors routinely collected by a standardized clinical instrument, the interRAI Resident Assessment Instrument for Palliative Care (interRAI-PC), in people with a prognosis of less than 12 months who wanted to die. METHODS All New Zealanders who had an interRAI-PC in 2018 were included. The outcome variable was the single item 'Wants to die now'. Independent variables included biopsychosocial factors and health index scales generated by interRAI-PC. A binary logistic regression was used to determine the predictive factors of 'Wants to die now' ('Yes' versus 'No'). RESULTS There were 771 individuals included (mean age 76.0 years, SD=11.6; female 50.1%); 9.3% of whom reported 'Yes' to 'Wants to die now', 59.8% 'No', and for 30.9%, the assessor was 'Unable to determine'. The factors with the largest odds ratios were awareness of terminal prognosis (OR=4.8; 95% CI=2.2-10.3), high level of depression (OR=4.6; 95% CI=1.7-12.6), not finding meaning in day-to-day life (OR=3.8; 95% CI=1.8-8.1), and pain (less than severe OR=3.7; 95% CI=1.3-10.4; severe to excruciating OR=3.5; 95% CI=1.1-10.7). CONCLUSION Addressing the significant factors we identified should form part of a multidisciplinary assessment when terminally ill patients express a wish to die, to ensure their physical, psychological and existential needs are adequately met. Chemotherapy causes various side effects, including cognitive impairment, known as 'chemobrain'. In this study, we determined whether a novel acupuncture mode called electroacupuncture trigeminal nerve stimulation plus body acupuncture (EA/TNS + BA) could produce better outcomes than minimum acupuncture stimulation (MAS) as controls in treating chemobrain and other symptoms in breast cancer patients. In this assessor- and participant-blinded, randomized controlled trial, 93 breast cancer patients under or post chemotherapy were randomly assigned to EA/TNS + BA (n = 46) and MAS (n = 47) for 2 sessions per week over 8 weeks. The Montreal Cognitive Assessment (MoCA) served as the primary outcome. Digit span test was the secondary outcomes for attentional function and working memory. The quality of life and multiple functional assessments were also evaluated. EA/TNS + BA treated group had much better performance than MAS-treated group on reverse digit span test at Week 2 and Week 8, with medium effect sizes of 0.53 and 0.48, respectively, although no significant differences were observed in MoCA score and prevalence of chemobrain between the two groups. EA/TNS + BA also markedly reduced incidences of diarrhoea, poor appetite, headache, anxiety, and irritation, and improved social/family and emotional wellbeing compared to MAS. These results suggest that EA/TNS + BA may have particular benefits in reducing chemotherapy-induced working memory impairment and the incidence of certain digestive, neurological, and distress-related symptoms. It could serve as an effective intervention for breast cancer patients under and post chemotherapy (trial registration https//www.clinicaltrials.gov NCT02457039). BACKGROUND AND AIMS Following an infection, cytokines not only regulate the acute immune response, but also contribute to symptoms such as inflammatory hyperalgesia. We aimed to characterize the acute inflammatory response induced by a human endotoxemia model, and its effect on pain perception using evoked pain tests in two different dose levels. We also attempted to determine whether combining a human endotoxemia challenge with measurement of pain thresholds in healthy subjects could serve as a model to study drug effects on inflammatory pain. METHODS AND RESULTS This was a placebo-controlled, randomized, cross-over study in 24 healthy males. Twelve subjects were administered a bolus of 1 ng/kg LPS intravenously, and twelve 2 ng/kg LPS. Before days of placebo/LPS administration, subjects completed a full study day without study drug administration, but with identical pain threshold testing. Blood sampling and evoked pain tests (electrical burst and -stair, heat, pressure, and cold pressor test) were performed pre-dose and at frequent intervals up to 10hr post-dose. Data were analysed with a repeated-measures ANCOVA. For both dose levels, LPS induced an evident acute inflammatory response, but did not significantly affect any of the pain modalities. In a post-hoc analysis, lowering of pain thresholds was observed in the first 3 h after dosing, corresponding with the peak of the acute inflammatory response around 1-3 h post-dose. CONCLUSION Mild acute systemic inflammation, as induced by 1 ng/kg and 2 ng/kg LPS intravenous administration, did not significantly change pain thresholds in this study. The endotoxemia model in combination with evoked pain tests is not suitable to study acute inflammatory hyperalgesia in healthy males.