Curriecotton9375

08-66.08-70.28, p-value = 0.021), Content of descriptive speech (9.57-6.69-7.22, p-value = 0.034), Verbal fluency (6.57-3.54-3.89, p-value = 0.002), Auditory comprehension (9.71-7.54-7.78, p-value = 0.039), Complex auditory commands (9.71-7.65-7.56, p-value = 0.043), Repetition (9.75-7.08-7.61, p-value = 0.036), Naming (9.93-7.15-8.11, p-value = 0.046). Following TBI, CT findings on admission can significantly predict long-term language abilities, with left side lesions inducing poorer outcomes.The steady growth of corporate interest and influence in the health care sector over the past few decades has created a more business-oriented health care system in the United States, helping to spur for-profit and private equity investment. Proponents say that this trend makes the health care system more efficient, encourages innovation, and provides financial stability to ensure access and improve care. Critics counter that such moves favor profit over care and erode the patient-physician relationship. American College of Physicians (ACP) underscores that physicians are permitted to earn a reasonable income as long as they are fulfilling their fiduciary responsibility to provide high-quality, appropriate care within the guardrails of medical professionalism and ethics. In this position paper, ACP considers the effect of mergers, integration, private equity investment, nonprofit hospital requirements, and conversions from nonprofit to for-profit status on patients, physicians, and the health care system.

Qaseem A, Etxeandia-Ikobaltzeta I, Fitterman N, et al.

Ann Intern Med. 2021;174977-84. 33900796.

Qaseem A, Etxeandia-Ikobaltzeta I, Fitterman N, et al. Appropriate use of high-flow nasal oxygen in hospitalized patients for initial or postextubation management of acute respiratory failure a clinical guideline from the American College of Physicians. Ann Intern Med. 2021;174977-84. 33900796.

, a multidrug-resistant yeast, can spread rapidly in ventilator-capable skilled-nursing facilities (vSNFs) and long-term acute care hospitals (LTACHs). In 2018, a laboratory serving LTACHs in southern California began identifying species of

that were detected in urine specimens to enhance surveillance of

, and

was identified in February 2019 in a patient in an Orange County (OC), California, LTACH. Further investigation identified

at 3 associated facilities.

To assess the prevalence of

and infection prevention and control (IPC) practices in LTACHs and vSNFs in OC.

Point prevalence surveys (PPSs), postdischarge testing for

detection, and assessments of IPC were done from March to October 2019.

All LTACHs (

= 3) and vSNFs (

= 14) serving adult patients in OC.

Current or recent patients in LTACHs and vSNFs in OC.

In facilities where

was detected, PPSs were repeated every 2 weeks. Ongoing IPC support was provided.

Antifungal susceptibility testing and whole-genome sequencing to assess isolate relatedness.

Initial PPSs at 17 facilities identified 44 additional patients with

in 3 (100%) LTACHs and 6 (43%) vSNFs, with the first bloodstream infection reported in May 2019. By October 2019, a total of 182 patients with

were identified by serial PPSs and discharge testing. Of 81 isolates that were sequenced, all were clade III and highly related. Assessments of IPC identified gaps in hand hygiene, transmission-based precautions, and environmental cleaning. The outbreak was contained to 2 facilities by October 2019.

Acute care hospitals were not assessed, and IPC improvements over time could not be rigorously evaluated.

Enhanced laboratory surveillance and prompt investigation with IPC support enabled swift identification and containment of

.

Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention.

Krist AH, Davidson KW, Mangione CM, et al.

JAMA. 2021;3251436-42. 33847711.

Krist AH, Davidson KW, Mangione CM, et al. Screening for vitamin D deficiency in adults US Preventive Services Task Force recommendation statement. JAMA. 2021;3251436-42. 33847711.

Qaseem A, Etxeandia-Ikobaltzeta I, Mustafa RA, et al.

Ann Intern Med. 2021;174985-93. 33900792.

Qaseem A, Etxeandia-Ikobaltzeta I, Mustafa RA, et al. Appropriate use of point-of-care ultrasonography in patients with acute dyspnea in emergency department or inpatient settings a clinical guideline from the American College of Physicians. Ann Intern Med. 2021;174985-93. 33900792.

Lundgren JR, Janus C, Jensen SBK, et al.

N Engl J Med. 2021;3841719-30. 33951361.

Lundgren JR, Janus C, Jensen SBK, et al. Healthy weight loss maintenance with exercise, liraglutide, or both combined. N Engl J Med. selleck kinase inhibitor 2021;3841719-30. 33951361.

Syn NL, Cummings DE, Wang LZ, et al.

Lancet. 2021;3971830-41. 33965067.

Syn NL, Cummings DE, Wang LZ, et al. Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants. Lancet. 2021;3971830-41. 33965067.

Yang W, Sun C, He SQ, et al.

J Gen Intern Med. 2021;362085-93. 33846938.

Yang W, Sun C, He SQ, et al. The efficacy and safety of disease-modifying osteoarthritis drugs for knee and hip osteoarthritis-a systematic review and network meta-analysis. J Gen Intern Med. 2021;362085-93. 33846938.

Velayudhan L, McGoohan K, Bhattacharyya S.

PLoS Med. 2021;18e1003524. 33780450.

Velayudhan L, McGoohan K, Bhattacharyya S. Safety and tolerability of natural and synthetic cannabinoids in adults aged over 50 years a systematic review and meta-analysis. PLoS Med. 2021;18e1003524. 33780450.

Giugliano D, Longo M, Caruso P, et al.

Diabetes Care. 2021;441353-60. 33883195.

Giugliano D, Longo M, Caruso P, et al. Feasibility of simplification from a basal-bolus insulin regimen to a fixed-ratio formulation of basal insulin plus a GLP-1RA or to basal insulin plus an SGLT2 inhibitor BEYOND, a randomized, pragmatic trial. Diabetes Care. 2021;441353-60. 33883195.

Stiell IG, Sivilotti MLA, Taljaard M, et al.

CJEM. 2021;23314-24. 33959925.

Stiell IG, Sivilotti MLA, Taljaard M, et al. A randomized, controlled comparison of electrical versus pharmacological cardioversion for emergency department patients with acute atrial flutter. CJEM. 2021;23314-24. 33959925.

Tsang NN, So HC, Ng KY, et al.

Lancet Infect Dis. 2021. [Epub ahead of print.] 33857405.

Tsang NN, So HC, Ng KY, et al. Diagnostic performance of different sampling approaches for SARS-CoV-2 RT-PCR testing a systematic review and meta-analysis. Lancet Infect Dis. 2021. [Epub ahead of print.] 33857405.A 70-year-old man had an acute type B aortic dissection 9 years before his admission. The last enhanced computed tomography that was performed revealed an aneurysm that extended from the ascending aorta to the aortic arch, associated with a chronic aortic dissection, which extended from the aortic arch to the left external iliac artery. His visceral arteries originated from the false lumen. We performed a total arch replacement with a frozen elephant trunk in the hybrid operating room. Immediately after the circulatory arrest termination, using intraoperative angiography, we verified that the blood supply to the visceral arteries was patent.

This research adds to the scarce literature regarding adolescent experiences of traumatic brain injury (TBI). It uses a qualitative methodology to explore the symptoms experienced after sustaining a TBI at this unique stage of development including their persistence into adulthood.

Thirteen adults (aged 20-25years; mean 23years) who sustained a mild-moderate TBI during adolescence (aged 13-17years at injury), approximately 7.7years (range=6.7-8.0years) prior, participated in the research. Semi-structured individual interviews, analyzed using thematic analysis, explored participants' experiences surrounding and following their TBIs.

TBI during adolescence can result in significant acute symptoms, particularly headaches, fatigue, and difficulties in thinking. Participants' descriptions of the extent and impact of these symptoms reflected feelings of frustration and often anxiety and/or depression. Difficulties could persist for years post-TBI and sometimes had not resolved at all.

Even mild TBI during adolescence can result in significant acute and ongoing symptoms, which can contribute to emotional distress in the long term.

Even mild TBI during adolescence can result in significant acute and ongoing symptoms, which can contribute to emotional distress in the long term.

Respiratory syncytial virus (RSV) causes substantial morbidity and mortality in older adults. We assessed severe clinical outcomes among hospitalized adults that were associated with RSV infections.

We performed a nested retrospective study in 3 New York City hospitals during 2 respiratory viral seasons, October 2017-April 2018 and October 2018-April 2019, to determine the proportion of patients with laboratory-confirmed RSV infection who experienced severe outcomes defined as intensive care unit (ICU) admission, mechanical ventilation, and/or death. We assessed factors associated with these severe outcomes and explored the effect of RSV-associated hospitalizations on changes in the living situations of surviving patients.

Of the 403 patients studied (median age, 69 years), 119 (29.5%) were aged ≥80. Severe outcomes occurred in 19.1% of patients, including ICU admissions (16.4%), mechanical ventilation (12.4%), and/or death (6.7%). Patients admitted from residential living facilities had a 4.43 times higher likelihood of severe RSV infection compared with patients who were living in the community with or without assistance from family or home health aides. At discharge, 56 (15.1%) patients required a higher level of care than at admission.

RSV infection was associated with severe outcomes in adults. Living in a residential facility at admission was a risk factor for severe outcomes and could be a proxy for frailty rather than an independent risk factor. Our data support the development of prevention strategies for RSV infection in older populations, especially older adults living in residential living facilities.

RSV infection was associated with severe outcomes in adults. Living in a residential facility at admission was a risk factor for severe outcomes and could be a proxy for frailty rather than an independent risk factor. Our data support the development of prevention strategies for RSV infection in older populations, especially older adults living in residential living facilities.Over the past decade, soluble guanylate cyclase (sGC) activators and stimulators have been developed and studied to improve outcomes in patients with heart failure with reduced ejection fraction (HFrEF). The sGC enzyme plays an important role in the nitric oxide (NO)-sGC-cyclic guanosine monophosphate (cGMP) pathway, that has been largely untargeted by current guideline directed medical therapy (GDMT) for HFrEF. Disruption of the NO-sCG-cGMP pathway can be widely observed in patients with HFrEF leading to endothelial dysfunction. The disruption is caused by an oxidized state resulting in low bioavailability of NO and cGMP. The increase in reactive oxygen species can also result in an oxidized, and subsequently heme free, sGC enzyme that NO is unable to activate, furthering the endothelial dysfunction. The novel sGC stimulators enhance the sensitivity of sGC to NO, and independently stimulate sGC, while the sGC activators target the oxidized and heme free sGC to stimulate cGMP production. This review will discuss the pathophysiologic basis for sGC stimulator and activator use in HFrEF, review the pre-clinical and clinical data, and propose a place in the HFrEF armamentarium for this novel pharmacotherapeutic class.